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目的:应用二维斑点追踪技术(2D-STI)定量评价单纯风湿性二尖瓣狭窄(RMS)患者瓣膜置换术后左心功能的改变。方法:40例明确诊断为RMS且左心室射血分数>50%的患者,分别于术前、术后15d、3个月、12个月行常规超声心动图测量并记录左心房收缩末期内径(LAESD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、缩短率(LVFS)。应用2D-STI技术获得心尖位长轴切面整体纵向应变及左室各短轴切面整体圆周应变值作为评估指标,应用一阶自回归型协方差结构模型进行混合效应模型分析术前术后各时间段患者左心功能改变情况。结果:1常规心脏超声结果比较:术后LAESD、LVEDD、LVESD较术前总体均有明显改善(P<0.05),其中LAESD较术前减小,LVEDD、LVESD较术前增大,LVEF、LVFS较术前总体无统计学差异,术后3个时间点上述五个参数两两比较均无统计学意义。2二维斑点追踪技术结果比较:二尖瓣置换术后心尖位各长轴切面整体纵向应变值各时间段总体均明显大于术前(P<0.01),短轴各水平切面的整体圆周应变值各时间段总体均明显大于术前(P<0.01),两两比较结果显示,随着随访时间延长,各切面应变值逐渐增大,差异均有统计学意义(P<0.05)。结论:RMS患者瓣膜置换术后左心功能较术前明显好转。应用2D-STI可较准确地评价RMS患者术后左心功能的变化,为临床提供重要信息。
Objective: To quantitatively evaluate left ventricular function after valvular replacement in patients with rheumatic mitral stenosis (RMS) by 2D-STI. Methods: Forty patients with definite diagnosis of RMS and left ventricular ejection fraction> 50% underwent routine echocardiography before surgery, 15 days, 3 months and 12 months after operation. The end-systolic diameter LAESD, LVEDD, LVESD, LVEF and LVFS. 2D-STI technique was used to obtain the longitudinal strain of the long axis of the apical long axis and the global circumferential strain of each short axis of the left ventricular as the assessment index. The first-order autoregressive covariance model was used to analyze the effect of the mixed effect on the preoperative and postoperative time Paragraph patients with left ventricular function changes. Results: 1 Comparison of conventional echocardiography: The LAESD, LVEDD and LVESD were significantly improved (P <0.05), the LAESD was lower than preoperative, the LVEDD and LVESD were increased, LVEF, LVFS Compared with the preoperative total no statistical difference, three time points after the above five parameters were no significant difference between each other. The results of two-dimensional speckle tracking showed that the global longitudinal strain of each major axis of mitral valve replacement was significantly higher than that of preoperative (P <0.01), and the global circumferential strain The results showed that with the extension of follow-up time, the strain values of each section increased gradually, with significant differences between the two groups (P <0.05). Conclusion: Left ventricular function in patients with RMS after valvular replacement is better than that before operation. The application of 2D-STI can be more accurate evaluation of RMS patients with left ventricular function changes, provide important information for the clinical.