4D RV Volume软件评价尿毒症患者右心室收缩功能及维持性血液透析对其影响

Evaluation of right ventricular systolic function and effects of maintenance hemodialysis on it in uremic patients by 4D RV Volume

目的运用4D RV Volume软件获取尿毒症患者右室容积及应变参数,评价右室收缩功能及维持性血液透析对其右室收缩功能的影响。方法尿毒症患者76例,根据左室射血分数(LVEF)分为LVEF正常组和LVEF减低组,其中LVEF正常组根据是否接受透析治疗分为维持性血液透析组(简称血透组)和未透析组,同时选取对照组22例。常规超声参数包括LVEF、肺动脉峰值收缩压(PASP)、三尖瓣环收缩期位移(TAPSE-2D);4D RV Volume获取参数包括右室舒张末容积(RVEDV)、三尖瓣环收缩期位移(TAPSE-4D)、右室面积变化率(FAC)、右室射血分数(RVEF)、右室游离壁纵向收缩期应变(RV-GLSfree)。结果①与对照组比较,尿毒症LVEF减低组TAPSE-2D显著减低(P<0.05),尿毒症LVEF正常组TAPSE-2D差异无统计学意义(P>0.05)。与对照组及尿毒症LVEF正常组比较,尿毒症LVEF减低组PASP显著增高(均P<0.05)。与对照组比较,尿毒症LVEF正常组及尿毒症LVEF减低组RVEDV均显著增大,且在三组间呈递增趋势(均P<0.05),TAPSE-4D、FAC、RVEF、RV-GLSfree均显著减低,且在三组间呈递减趋势(均P<0.05)。②与对照组比较,尿毒症未透析组TAPSE-2D显著减低(P<0.05),尿毒症血透组TAPSE-2D差异无统计学意义(P>0.05);与对照组比较,尿毒症血透组及未透析组PASP均显著增高,RVEDV均显著增大,TAPSE-4D、FAC、RVEF、RV-GLSfree均显著减低(均P<0.05);与尿毒症未透析组比较,尿毒症血透组TAPSE-2D、TAPSE-4D显著增高(均P<0.05),而RVEDV、FAC、RVEF、RV-GLSfree差异无统计学意义(P>0.05)。结论4D RV Volume能准确、早期评估尿毒症患者右室收缩功能;接受维持性血液透析治疗的尿毒症患者右室收缩功能应结合右室应变及容积参数等综合评估。

Objective To evaluate the right ventricular systolic function in uremia patients and the effects of maintenance hemodialysis on right ventricular systolic function by volume and strain parameters obtained by 4D RV Volume.Methods Seventy-six patients with uremia and twenty-two controls were selected.According to left ventricular ejection fraction(LVEF),uremia patients were divided into normal LVEF uremia group and decreased LVEF uremia group.Then normal LVEF uremia group was divided into maintenance hemodialysis group and non-dialysis group.Conventional ultrasound parameters included:LVEF,pulmonary artery systolic pressure(PASP)and tricuspid annular plane systolic excursion(TAPSE-2D).4D RV Volume parameters included:right ventricular end-diastolic volume(RVEDV),tricuspid annular plane systolic excursion(TAPSE-4D),right ventricular area change rate(FAC),right ventricular ejection fraction(RVEF)and right ventricular free wall longitudinal systolic strain(RV-GLSfree).Results①Compared with the control group,TAPSE-2D decreased significantly in the decreased LVEF uremia group(P<0.05),while there was no significant difference of TAPSE-2D in normal LVEF uremia group(P>0.05).Compared with the control group and normal LVEF uremia group,PASP increased significantly in the decreased LVEF uremia group(P<0.05).Compared with the control group,RVEDV increased significantly both in the normal LVEF and decreased LVEF uremia group,which showed an increasing trend in these three groups(P<0.05),while TAPSE-4D,FAC,RVEF and RV-GLSfree all decreased significantly and showed a decreasing trend in these three groups(P<0.05).②Compared with the control group,TAPSE-2D decreased significantly in non-dialysis group(P<0.05),but there was no significant difference in uremia hemodialysis group(P>0.05).Compared with the control group,PASP and RVEDV increased and TAPSE-4D,FAC,RVEF and RV-GLSfree decreased significantly in uremia hemodialysis group and non-dialysis group(P<0.05).Compared with non-dialysis group,TAPSE-2D and TAPSE-4D increased significantly in hemodialysis group(P<0.05),while there was no significant difference in RVEDV,FAC,RVEF and RV-GLSfree in uremia hemodialysis group(P>0.05).Conclusions 4D RV Volume could early and accurately evaluate the right ventricular systolic dysfunction in uremia patients.Furthermore,when evaluating right ventricular systolic function in uremia patients treated with maintenance hemodialysis,indices such as right ventricular strain and volume parameters should be comprehensively considered.