速度向量成像分层应变技术评价血液透析对尿毒症患者左心室心肌即时纵向应变的影响

Velocity vector imaging in evaluation of impact of hemodialysis on left ventricular longitudinal strain of myocardium in uremia patients

目的观察速度向量成像(VVI)分层应变技术评价尿毒症血液透析患者左心室心肌即时纵向应变功能变化的价值。方法对35例接受高通量血液透析的尿毒症患者分别于透析前和透析后2 h行二维超声心动图检查。常规测量并采集图像后,应用VVI软件分析二维动态图像,获得左心室17个节段3层心肌收缩期纵向峰值应变(LPS)。结果透析后左心房收缩期前后径、左心室舒张末期和收缩末期内径、左心室舒张末期和收缩末期容积、每搏输出量均较透析前减小(P均<0.05),左心室射血分数差异无统计学意义(P=0.183)。与透析前比较,透析后2 h左心室整体全层、内层,基底段全层、内层、中层、外层,中间段全层、内层心肌收缩期LPS均较透析前减低(P均<0.05);左心室整体外层、中层,中间段外层、中层,心尖段全层、内层、中层、外层心肌LPS差异均无统计学意义(P均>0.05)。结论 VVI分层应变技术可敏感、准确地评价血液透析对尿毒症患者即时左心室心肌整体及局部收缩功能的影响。

Objective To investigate the value of velocity vector imaging (VVI) technique in evaluation of the impact of hemodialysis on left ventricular longitudinal strain of myocardium in uremia patients.Methods Echocardiography was performed in 35 uremia patients who underwent high flux hemodialysis before and 2 h after dialysis.The peak systolic longitudinal strain (LPS) of 3 layers at 17 segments of left ventricular were obtained using VVI software after conventional measurement.Results The left atrial diameter,left ventricular end diastolic and end systolic diameter,left ventricular end diastolic and end systolic volume as well as stroke volume reduced after dialysis (all P<0.05).There was no significant difference of left ventricular ejection fraction (P=0.183).Compared with before dialysis,the LPS of left ventricular global all layer and subendocardial layer,the all layer,subendocardial layer,middle layer and epicardial layer of the basal segment,the all layer and subendocardial layer of middle segment were lower than those before dialysis (all P<0.05).No significant difference was found in LPS of global epicardial,middle layer,epicardial layer of middle segment,all layer and three layers of apical segments before and 2 h after dialysis (all P>0.05).Conclusion VVI technique can sensitively and accurately evaluate the impact of hemodialysis on the global and local systolic function of left ventricular myocardium in uremic patients.