二维斑点追踪成像技术对脓毒症患者左心功能的研究

Study on two-dimensional speckle tracing imaging for left ventricular function in sepsis patients

目的研究二维斑点追踪成像(2D-STI)技术对脓毒症患者左心功能的临床意义。方法选择2014年1月至2015年12月期间在浙江省人民医院重症监护室住院的81例脓毒症患者作为观察组,同时期的81例健康体检者作为对照组。比较两组患者的一般资料,左室收缩末期内径(LVESd)、舒张期末左心室内径(LVEDd)、室间隔厚度(IVSD)、每搏输出量(SV)及左室射血分数(LVEF)、二尖瓣口舒张早期峰值流速(E峰)、二尖瓣口舒张晚期峰值流速(A峰)、E波速度下降时间(DT)等常规超声心电图参数,左心室收缩期峰值整体纵向应变(GLS)、整体圆周应变(GCS)及整体径向应变(GRS),左室收缩期长轴向应变达峰时间标准差(Tssl-SD)、径向应变达峰时间标准差(Tssr-SD)、圆周应变达峰时间标准差(Tssc-SD)、左室收缩期长轴向应变达峰时间最大差值(Tssl-Dif)、径向应变达峰时间最大差值(Tssr-Dif)以及圆周应变达峰时间最大差值(Tssc-Dif)等2D-STI指标,并采用Spearman相关分析二维应变参数与LVEF的相关性。结果观察组患者的LVEF [(62±5)%vs.(68±7)%]水平明显低于对照组(t=5.109,P <0.001)。观察组患者的GLS [(-18.4±3.1)%vs.(-20.3±2.1)%]、GRS [(28.3±2.1)%vs.(26.6±4.2)%]、GCS [(-23.8±1.2)%vs.(-24.4±2.4)%]、Tssl-SD [(45.3±3.2)ms vs.(19.3±1.3)ms]、Tssr-SD [(32.1±2.9)ms vs.(21.3±1.8)ms]、Tssl-Dif [(103±13)ms vs.(30±25)ms]、Tssr-Dif [(281±23)ms vs.(160±11)ms]以及Tssc-Dif [(242±12)ms vs.(169±13)ms]均显著高于对照组(t=4.828、4.983、2.165、77.772、31.516、0.753、35.843、27.645,P均<0.05)。Spearman相关分析结果显示,GLS (r=-0.644,P=0.005)、Tssl-SD(r=-3.553,P <0.001)、Tssr-SD(r=-3.715,P <0.001)、Tssl-Dif(r=-2.944,P <0.001)、Tssr-Dif(r=-0.842,P=0.003)以及Tssc-Dif(r=-0.811,P=0.003)均与LVEF呈明显的负相关;而GCS(r=-0.085,P=0.513)及GRS(r=-0.054,P=0.517)与LVEF均无明显相关性。结论 2DSTI指标可以客观地评价脓毒症患者左心室的收缩功能异常以及同步性情况,对其心脏情况的早期诊断具有重要的价值。

Objective To study the clinical significance of two-dimensional speckle tracking imaging (2D-STI) in the treatment of left ventricular function in patients with sepsis. Methods Totally 81 patients with sepsis who were hospitalized in the Department of Intensive Care Medicine of Zhejiang Provincial People's Hospital from January 2014 to December 2015 were selected as the observation group, while 81 healthy subjects in the same period as the control group. The general data, left ventricular end systolic diameter (LVESd), left ventricular end diastolic diameter (LVEDd), interventricular septum diastolic (IVSD), stroke volume (SV), left ventricular ejection fraction (LVEF), early diastolic peak of mitral orifice (E peak), late diastolic peak of mitral orifice (A peak), E-wave velocity descent time (DT), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), standard deviation of time to peak systolic longitudinal strain (Tssl-SD), standard deviation of time to peak systolic radial strain (Tssr-SD), standard deviation of time to peak systolic circumferrntial strain (Tssc-SD), maximum difference of Tssl (Tssl-Dif), maximum difference of Tssr (Tssr-Dif), maximum difference of Tssc (Tssc-Dif) of these two groups were compared. The relations between two-dimensional strain parameters and LVEF were analyzed by Spearman correlation. Results LVEF in the observation group [(62 ± 5)% vs.(68 ± 7)%] was significantly lower than that in the control group (t = 5.109, P < 0.001). In the observation group, GLS [(-18.4 ± 3.1)% vs.(-20.3 ± 2.1)%], GRS [(28.3 ± 2.1)% vs.(26.6 ± 4.2)%], GCS [(-23.8 ± 1.2)% vs.(-24.4 ± 2.4)%], Tssl-SD [(45.3 ± 3.2) ms vs.(19.3 ± 1.3) ms], Tssr-SD [(32.1 ± 2.9) ms vs.(21.3 ± 1.8) ms], Tssl-Dif [(103 ± 13) ms vs.(30 ± 25) ms], Tssr-Dif [(281 ± 23) ms vs.(160 ± 11) ms], and Tssc-Dif [(242 ± 12) ms vs.(169 ± 13) ms] were significantly higher than those in the control group (t = 4.828, 4.983, 2.165, 77.772, 31.516, 0.753, 35.843, 27.645;all P < 0.05). Spearman correlation analysis showed that GLS (r =-0.644, P = 0.005), Tssl-SD (r =-3.553, P < 0.001), Tssr-SD (r =-3.715, P < 0.001), Tssl-Dif (r =-2.944, P < 0.001), Tssr-Dif (r =-0.842, P = 0.003) and Tssc-Dif (r =-0.811, P = 0.003) were negatively associated with LVEF, while GCS (r =-0.085, P = 0.513) and GRS (r =-0.054, P = 0.517) were not associated with LVEF. Conclusion The 2D-STI index can objectively evaluate the systolic dysfunction and synchrony of left ventricle, and has important value in the early diagnosis of cardiac conditions in sepsis patients.