斑點追蹤超聲心動圖定量評價肺切除術(shù)患者右心室心肌收縮功能

摘要： 目的運(yùn)用斑點追蹤超聲心動圖定量評價經(jīng)過肺切除術(shù)的患者手術(shù)前后右心室心肌收縮功能的改變。方法經(jīng)胸壁采集7例全肺切除術(shù)與23例肺葉切除術(shù)手術(shù)前及術(shù)后1周左室心尖四腔切面和右室乳頭肌水平短軸切面的二維灰階動態(tài)圖像。采用二維應(yīng)變技術(shù)分析軟件測量右室游離壁與室間隔的縱向、圓周及徑向應(yīng)變。術(shù)前、術(shù)后的檢測結(jié)果進(jìn)行自身對比;同時比較兩組各個參數(shù)的測值。結(jié)果 (1)兩組右室游離壁與室間隔的縱向應(yīng)變、圓周應(yīng)變及徑向應(yīng)變術(shù)前與術(shù)后相比均顯著降低(P<0.05)。(2)兩組各個參數(shù)的測值術(shù)前相比差異無統(tǒng)計學(xué)意義(P>0.05);全肺切除術(shù)組右室游離壁的基底段、中間段縱向應(yīng)變及右室心肌整體縱向應(yīng)變術(shù)后測值與肺葉切除術(shù)組相比顯著減低(P<0.05),余參數(shù)的測值相比較無顯著性差異(P>0.05)。結(jié)論斑點追蹤超聲心動圖能準(zhǔn)確、定量地評價右心室心肌收縮功能。肺切除術(shù)的患者手術(shù)后右心室心肌收縮功能與手術(shù)前相比均顯著降低。肺切除范同的大小主要影響右室游離壁心肌及右室心肌整體的縱向應(yīng)變。
Objective To evaluate the changes of right ventricular peak systolic strain using speckle tracking echocardiography after lung resections. Methods Seven patients undergoing pneumonectomy and 23 receiving lobectomy were accessed before surgery and 1 week postoperatively. The apical four chamber view of left ventriclar and right ventriclar short-axis view at the levels of papillary muscle with high frame rate were recorded. Longitudinal, circumferential and radial strains were measured in both the right ventricular free wall (RVFW) and the interventricular sep turn by 2-dimensional strain analysis software. The preoperative values and postoperative ones were compared. Values were compared between the two groups. Results 1. All parameters were significantly lower in patients undergoing lung resections (P<0.05) . 2. There was no significant difference in all parameters between the two groups before surgery (P>0.05) . RVFW basal and mid segments of longitudinal peak systolic strain and right ventriclar longitudinal global peak systolic strain in the lobectomy group were significantly higher than those in the pneumonectomy group 1 week postoperatively (P<0.05), but the difference between the rest was not significant (P>0.05) . Conclusions Speckle tracking echocardiography can accurately quantify the right ventricular systolic funtion. The dysfunction of right ventricular is evidently lower in the early postoperative period. The more lung resections are, the lower the RVFW longitudinal peak systolic strain and RV longitudinal global peak systolic strain can be.