超声斑点追踪技术评价肺叶切除对右心功能的影响

Effect of lobectomy on right heart function evaluated by ultrasound speckle tracking technique

目的采用二维超声心动图斑点追踪技术(2D-STI)及三维超声心动图斑点追踪技术(3D-STI)评估肺叶切除术患者右心功能的变化规律。方法纳入2021年3月~2022年3月于中国科学技术大学附属第一医院(安徽省立医院)胸外科行肺叶切除术的患者77例,完成随访45例,均行常规超声心动图、2D-STI和3D-STI检查,采用实时三维超声心动图采集肺叶切除术患者心脏全容积图像,采用TomTec成像系统进行脱机分析,比较术前及术后1、3、6月各检查参数的差异。结果肺叶切除术对患者右心影响较左心大。2D-STI技术较3D-STI技术对肺叶切除术患者右心功能评估更敏感,且肺叶切除术对患者右室游离壁影响比间隔侧影响大,与术前相比,术后1月、3月二维右室纵向应变绝对值降低,差异有统计学意义(P<0.05),6月基本恢复术前水平;与术前相比,术后1月二维右室游离壁纵向应变、三维右室游离壁纵向应变绝对值均降低,差异有统计学意义(P<0.05),且术后3月基本恢复术前水平。三维右室间隔侧应变术后1、3、6月与术前的差异无统计学意义(P>0.05)。结论肺叶切除降低右心收缩功能,术后1月最为显著,术后6月基本恢复至术前水平。

Objective To assessed the changing patterns of right heart function in patients undergoing lobectomy by using two-dimensional echocardiographic speckle tracking technique(2D-STI)and three-dimensional echocardiographic speckle tracking technique(3D-STI).Methods Seventy-seven patients who underwent lobectomy in the Department of Thoracic Surgery of the First Hospital Affiliated to the University of Science and Technology of China(Anhui Provincial Hospital)from March 2021 to March 2022 were included,and 45 patients completed follow-up,all of whom underwent conventional echocardiography,2D-STI and 3D-STI,and real-time 3D echocardiography was used to capture the cardiac full-volume images of patients who had undergone lobectomy,and offline analysis of the TomTec imaging system was used to compare the differences in each examination parameter before and 1,3,6 months after surgery.Results Lobectomy affects the right heart of patients more than the left heart.2D-STI technology is more sensitive to the assessment of right heart function in patients undergoing lobectomy than 3D-STI technology,and lobectomy affects the right ventricular free wall of patients more than the septal side.Compared with the preoperative period,the absolute value of 2D right ventricular longitudinal strains was reduced in at 1 and 3 months after surgery,with a statistically significant difference(P<0.05),and basically restored to the preoperative level at 6 months after surgery.Compared with the preoperative period,the absolute values of 2D right ventricular free wall longitudinal strain and 3D right ventricular free wall longitudinal strain were reduced at 1 and 3 months after surgery,and the difference was statistically significant(P<0.05),and the preoperative level was basically restored at 3 months after surgery.There was no statistically significant difference in 3D right ventricular septal lateral strain between postoperative 1,3,6 months and preoperative(P>0.05).Conclusion Lobectomy reduces right heart systolic function,most significantly at 1 month postoperatively,and returns essentially to preoperative levels at 6 months postoperatively.