单次透析前后右心室功能改变的三维斑点追踪技术评价

Evaluation of a single hemodialysis on right ventricular function in patients by 3-dimensional speckle tracking imaging

目的探讨三维超声斑点追踪成像（3D-STI）技术在单次血液透析前后右心室功能评价中的应用。方法分析76例终末期肾病（ESRD）患者单次透析前后的右心室功能，根据左室射血分数（LVEF）分为LVEF正常组（A组，LVEF≥50％，46例）和LVEF减低组（B组，LVEF〈50％，30例）；选取35例健康志愿者作为对照组。记录临床数据、常规超声数据及右心3D-STI参数：右室舒张末容积（RVEDV）、右室收缩末容积（RVESV）、右室射血分数（RVEF）、右室间隔纵向应变[RVLs（Septum）]、右室游离壁纵向应变[RVLS（Freewall）]、右室基底段内径[RVDd（base）]、右室中间段内径[RVDd（mid）]、右室长径（RVLD）及右室面积变化分数（FAC），并对透析前后数据进行对比。结果①组间比较：A、B两组透析前RVEDV、RVESV、RVDd（base）、RVDd（mid）及RVLD均较对照组显著增高（P〈0．05）；RVEF、RVLS（Freewall）、RVLS（Septum）及FAC较对照组显著减低（P〈0．05）；②组内比较：A组透析后RVEDV、RVESV、RVEF、RVLD及RVLS（Freewall）均较透析前减低（P〈0．05）；B组透析后RVEDV、RVESV、RVEF、RVLS（Septum）、及RVLS（Freewall）均较透析前减低（P〈0．05）；B组透析前RVEDV、RVESV、RVEF、RVLS（Septum）及RVLS（Freewall）均低于A组透析前（P〈0．05）；单次透析后B组RVLS（Septum）降低差值大于A组，且A、B组RVLS（Freewall）降低差值均与体重下降差值显著相关（A组：r=0．351，P=0．017；B组：r=0．696，P=0．000）。结论单次透析可导致右室收缩功能减退、应变值减低，且在合并左心功能减低组中表现更为明显；透析患者合理控制入水量可以延缓因透析引起的心功能受损。

Objective To evaluate the change of right ventricular function before and after single hemodialysis by 3-dimensional speckle tracking imaging（3D-STI）. Methods Seventy-six patients with endstage renal disease（ESRD） and 35 controls were included. ESRD patients were divided into normal left ventricular ejection fraction group（LVEF≥ 50%,46 cases, group A） and decreased LVEF group （ LVEF〈 50 %, 30 cases, group B）. Conventional echocardiography and 3D-STI parameters including right ventricular end diastolic volume（RVEDV）, right ventricular end systolic volume （RVESV）, right ventricular ejection fraction（RVEF）, right ventricular septal longitudinal strain E RVLS（Septum）], right ventricular free wall longitudinal strain [RVLS（Freewall）], basal segment of right ventrieular diameter ERVDd （base）], right ventricular middle diameter [RVDd（mid ）], right ventricular long diameter （RVLD） and the upper and lower right ventricular fractional area change （FAC） were performed in patients and controls before and after a single hemodialysis. Results （1）RVEDV, RVESV, RVDd（base）, RVDd（mid）, RVLD before a single hemodialysis in group A and B were significantly higher than those in control group （all P 〈0. 05）. RVEF, RVLS Freewall, RVLS（Septum） and FAC in group A and B were significantly lower than those in control group （all P〈0.05）. （2） RVEDV, RVESV, RVEF, RVLD, RVLS （Freewall） were significantly lower in group A after a single hemodialysis （all P 〈 0.05） ; RVEDV, RVESV, RVEF, RVLS （Freewall）, RVLS （Septum） were significantly lower in group B after a single hemodialysis（all P〈0.05）;RVEDV, RVESV, RVEF, RVLS（Septum） and RVLS（Freewall） in group B before a single hemodialysis were lower than those in group A （all P 〈0.05）. The difference of RVLS Septum decrease in group B after a single hemodialysis was higher than that in group A（ P 〈0.05） ;The linear correlations analysis showed that the difference of body weight before and after a single hemodialysis was negatively related with the difference of RVLS （Freewall） before and after a single hemodialysis（group A： r = 0.351, P = 0.017 ;group B： r = 0. 696, P = 0. 000）. Conclusions A single hemodialysis may have injurious effects on right ventricular systolic function and reduce strain value, which is more significant in group B（LVEF〈50%）. Cardiac dysfunction of patients may be remitted by reasonable control of water intake.