实时三维超声心动图监测乳腺癌化疗患者右心室功能的变化

Research on monitoring changes of right ventricular function in breast cancer patients undergoing chemotherapy by real time three-dimensional ultrasound

目的应用实时三维超声心动图(RT-3DE)监测乳腺癌化疗患者右心室功能的变化,评估化疗药物对右室功能的早期影响。方法选取2020年6月至2021年6月于我院行蒽环类化疗的乳腺癌患者52例。于化疗前基础状态(T_(0))及不同化疗周期(T_(1)、T_(3)、T_(5))结束后应用常规超声测量三尖瓣环收缩期位移(Tapse)、右室内径(RVd),同时应用RT-3DE测量3D-Tapse、右室射血分数(RVEF),比较化疗前后右室收缩功能指标的变化。结果常规超声参数:Tapse在T_(5)(21.20±2.77)mm较T_(0)(22.30±3.06)mm下降,差异有统计学意义(P<0.05);RVd在各化疗周期结束后,与T_(0)比较差异均无统计学意义(P>0.05)。RT-3DE超声参数:3D-Tapse在T_(5)(19.47±1.64)mm较T_(0)(20.23±1.90)mm下降,差异有统计学意义(P<0.05);RVEF在T_(3)(54.80±3.86)%较T_(0)(57.04±3.47)%下降,差异有统计学意义(P<0.01)。结论RT-3DE较常规超声能更早检测出蒽环类化疗药物导致的右室亚临床收缩功能减低,可为临床预防和干预化疗后右室功能障碍提供参考依据。

Objective To evaluate the early effect of chemotherapy drugs on right ventricular function,the changes of right ventricular function in breast cancer patients undergoing chemotherapy were monitored by real time three-dimensional echocardiography(RT-3DE).Methods 52 Breast cancer patients who received anthracycline chemotherapy in our hospital from June 2020 to June 2021 were enrolled.To compare the changes of right ventricular systolic function in different chemotherapy cycles,the tricuspid annular systolic displacement(Tapse)and right ventricular diameter(RVd)were measured by conventional ultrasound at the basic state before chemotherapy(T_(0))and the end of different chemotherapy cycles(T_(1)、T_(3)、T_(5)),while the 3D-Tapse and right ventricular ejection fraction(RVEF)were measured by RT-3DE.Results Routine ultrasonic showed that Tapse decreased at T_(5)(21.20±2.77)mm compared with T_(0)(22.30±3.06)mm(P<0.05).Compared with T_(0),there was no significant difference in RVd after each chemotherapy cycle(P>0.05).RT-3DE shows that 3D-Tapse was significantly lower at T_(5)(19.47±1.64)mm than T_(0)(20.23±1.90)mm(P<0.05),RVEF decreased at T_(3)(54.80±3.86)%compared with T_(0)(57.04±3.47)%(P<0.01).Conclusion Compared with conventional ultrasound,RT-3DE can detect the decrease of subclinical systolic function of right ventricle caused by anthracycline chemotherapy earlier,which can provide reference for clinical prevention and intervention of right ventricular dysfunction after chemotherapy.