超声对胸部放疗患者右心室收缩功能的评估

Evaluation of right ventricular systolic function in patients with thoracic radiotherapy by ultrasonography

目的探讨超声心动图评估胸部放疗对右心室收缩功能的影响。方法选取接受首次胸部放疗且放疗术野累及心脏的恶性肿瘤患者37例,于放疗前1周及放疗4周后分别测量一般临床指标、右心室容量参数及室壁厚度、右心室收缩功能参数。放疗前后各参数的比较采用配对t检验,以P<0.01为差异有统计学意义。结果放疗前后血压等一般资料比较,差异均无统计学意义(P>0.01)。放疗前后右室壁厚度(RV-WT)、右室基底部内径(RVD1)、右室中部内径(RVD2)、右室长径(RVD3)、右室流出道远端内径(RVOT1)、右室流出道近端内径(RVOT2)、右心室面积变化分数(FAC)比较,差异均无统计学意义(P>0.01)。放疗后三尖瓣环收缩期位移(TAPSE)、右心室等容收缩期心肌加速度(IVA)、三尖瓣环收缩期峰值速度(S')值与放疗前比较减小,差异有统计学意义(P<0.01)。放疗后右心室心肌做功指数(RIMP)值与放疗前比较增大,差异有统计学意义(P<0.01)。结论右室TAPSE、IVA、S'及RIMP值的测量不易受心室不规则几何形态的影响,是判断放疗后右心室收缩功能早期受损的敏感指标。

Objective To investigate the effect of thoracic radiotherapy on right ventricular systolic function by echocardiography.Methods Thirty-seven cases with malignant tumors who received the first thoracic radiotherapy and all of the radiotherapy fields involved the heart were selected.The general clinical parameters,right ventricular volume parameters,wall thickness and right ventricular systolic function parameters were measured one week before and four weeks after radiotherapy.The paired t-test was used to compare the above parameters before and after radiotherapy.Results There was no significant difference in comparison of general conditions such as blood pressure before and after radiotherapy.There were no significant differences in RV-WT,RVD1,RVD2,RVD3,RVOT1,RVOT2,FAC before and after radiotherapy.The values of TAPSE,IVA and S’decreased after radiotherapy(P<0.01).RIMP increased significantly after radiotherapy(P<0.01).Conclusion The measurement of TAPSE,IVA,S’and RIMP in the right ventricle is not easily affected by the irregular geometry of the ventricle.It is a sensitive index to evaluate the early damage of right ventricular systolic function after radiotherapy.