尿毒症患者肾移植术后左心房功能恢复情况的超声定量研究

Quantitative study of left atrial function yecovery in uremia patients after renal transplantation by Echocardiography

目的利用左心房追踪技术(left atrial volume tracking technology,LAVT)探讨尿毒症患者(uremia patients)肾移植术后左心房功能变化。方法选取2019年9月~2020年10月我院尿毒症行肾移植患者25例,于术前、术后1个月、3个月及6个月分别行超声心动图检查,采集相关数据,然后采集连续3个心动周期心尖四腔心和两腔心图像。用LAVT技术获取双平面左心房容积-时间变化曲线,获得左心房最大容积(LAVmax)、收缩期前容积(LAVpre)及最小容积(LAVmin),计算左心房总排空容积(LAVt)和左心房总排空分数(LAVtEF)、左心房被动排空容积(LAVp)、左心房被动排空分数(LAVpEF)、左心房主动排空容积(LAVa)、左心房主动排空分数(LAVaEF),各参数采用体表面积标化。结果1)与术前比较:术后1个月、3个月、6个月时LAVpEFi均增大(P<0.05);术后1个月、6个月时LAVpi均增大(P<0.05);术后6个月时LAVtEFi增大(P<0.05);术后1个月、术后6个月时LAVti增大(P<0.05);2)术后3组比较:与术后3个月比较,术后6个月LAVpi、LAVti数值均增大(P<0.05)。结论肾移植术后左心房管道功能均较术前增强,术后6个月时左心房储存功能增强,推测左心房管道功能改善时间上可能早于左心房存储器功能改善。左心房追踪技术能够精确、有效评价尿毒症患者肾移植术后左心房容积和功能变化,为临床提供了一种预后判断的方法。

Objective To evaluate the changes of left atrium function after kidney transplantation in Uremia patients by left atrial volume tracking technology(LAVT).Methods From 2019 to 2020,25 patients with uremia undenwent renal transplantation.Before operation,postoperation of 1 month,3 months and 6 months respectively after echocardiographic examination,related data were collected.The apical four-chamber and two-chamber images were obtained in 3 consecutive cardiac cycles.LAVT was used to obtain the biplane left atrial volume-time curve,to get the left atrial maximum volume(LAVmax),presystolic volume(LAVpre)and minimum volume(LAVmin).LAVt and LAVtEF,LAVp,LAVpEF,LAVa,LAVaEF were calculated.All parameters passed through the body standardized surface area.Results 1)Compared with preoperative LAVpEFi parameter,the values of LAVpEFi at 1 month,3 months and 6 months after the operation were all increased(P<0.05);Compared with preoperative LAVpi parameter,the values of LAVpi at 1 month,6 months after the operation were all increased(P<0.05);Compared with preoperative LAVtEFi,LAVtEFi value increased 6 months after operation(P<0.05);Compared with preoperative LAVti,LAVti values increased 1 month and 6 months after operation(P<0.05);2)Compared with LAVpi,LAVti 3 months after operation,the values of LAVpi,LAVti 6 months after operation were all increased(P<0.05).Conclusion After renal transplantation,the function of left atrial duct is enhanced,and the function of left atrial storage is enhanced at 6 months after renal transplantation,suggesting that the improvement time of left atrial duct function may be earlier than that of left atrial storage function.Left atrial tracking technique can accurately and effectively evaluate the changes of left atrial volume and function after renal transplantation in uremic patients,thus can provide a prognostic method for clinical practice.