超声血流向量成像技术评价胸腔镜肺切除术后舒张期左心室流体能量损耗

Left ventricular flow energy loss at diastolic phase in patients after video-assisted thoracic lung resection by ultrasonic vector flow mapping

目的应用超声血流向量成像（VFM）技术评价胸腔镜肺切除术后患者左心形态结构和心功能改变，定量评价左心室腔内流场状态改变对左心室舒张功能损害的诊断价值。方法选取36例胸腔镜肺切除术患者作为肺切除组，30例健康志愿者作为对照组。常规超声心动图测量左心室、左心房容积及左心室舒张功能相关参数。在VFM模式下分别获取舒张早期（ED）、舒张晚期（LD）左心室腔流体能量损耗（EL）相关参数。结果①左心室及左心房容积参数比较：两组间左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）、左房舒张末期容积（LAVd）差异均无统计学意义（P〉0．05）；肺切除组左房收缩末期容积（LAVs）和左房排空容积（LAVe）低于对照组，差异有统计学意义（P〈0．05）。②左心室舒张功能参数比较：肺切除组舒张早期峰值速度（E）、舒张晚期峰值速度（A）、舒张早期峰值速度／二尖瓣瓣环舒张早期组织速度比值（E／e）及心率高于对照组，E峰减速时间（EDT）和E／A比值低于对照组，差异均有统计学意义（P〈0，05）；两组间IVRT差异无统计学意义（P〉0．05）。③舒张早期左心室EL比较：两组间仅ELTB和ELAM差异有统计学意义（P〈0．05）。④舒张晚期左心室EL比较：肺切除组整体及各节段EL值均明显高于对照组，差异有统计学意义（P〈0．05）。结论VFM技术可以定量评价肺切除术后左心室腔内流体特征改变；EL增加可定量反映肺切除术后左心室舒张功能障碍。

Objective To evaluate the changes of left ventricular structure and cardiac function in patients after video-assisted thoracic pneumonectomy by ultrasonic vector flow mapping （VFM） and quantitatively evaluate the diagnostic value of left ventricular flow energy loss （EL） for pneumonectomy patients with impaired cardiac function. Methods Thirty-six pneumonectomy patients were selected as case group and 30 health cases as control group. The echoeardiographic parameters were acquired and left ventricular volume, left atrial volume and parameters of left diastolic founction were routinely measured. The EL of the left ventricularat early diastole and late diastole under the VFM mode were acquired. Results ①Left ventricular volume and left atrial volume comparsion： there was no significant difference in left ventricular end diastolic volume（LVEDV）, left ventricular end systolic volume（LVESV）, left ventricular ejective fraction（LVEF）, and left atrial end diastolic volume（LAVd） between the two groups （all P 〉 0.05） ;left atrial end systolic volume（LAVs） and left atrial emptying volume （LAVe） in case group were mild lower than control group（ P 〈0.05）. ②Comparsion of diastolic function parameters：E, A, E/e and HR of case group were significant higher than those in control group （all P 〈0.05）, EDT and E/A ratio in case group were significant lower than those in control group （all P 〈 0.05）, there was no significant difference of IVRT between two groups （ P 〉0.05）. ③Comparison of EL at early diastole： only ELTB and ELAM had mild difference between case group and control group （all P 〈0.05）. ④Comparison of EL at late diastolic： EL of entirety and each segment of left ventricle of case group increased （all P 〈 0.05）. Conclusions VFM can quantitatively evaluate the left ventricular flow characteristics after video-assisted thoracic pneumonectomy, and the increase in EL may reflect the left ventricular diastolic dysfunction in patients after pneumonectomy.