刘欢 曹云翔 钱大钧

[摘要] 目的：探讨实时三维超声心动图（RT-3DE）评价急性肺栓塞（APE）患者右心功能的价值。方法：使用RT-3DE采集30例APE患者和30例健康志愿者心脏全容积图像导入TomTec工作站，应用4D RV-Function软件分析，生成右室容积-时间变化曲线（RV-VTC）。比较两组对象RT-3DE参数右室舒张末期容积（EDV）、收缩末期容积（ESV），射血分数（EF），峰值排空率（PER）和峰值充盈率（PFR）之间的差异。结果：与对照组相比，APE患者右室整体EDV、 ESV增大，EF、PER、PFR减小，差异均有统计学意义（t=2.490、2.172、2.897、2.894及3.042，均P＜0.05）。结论：APE患者的右室整体收缩及舒张功能减低，RT-3DE可以准确评价APE患者右心功能改变。

[关键词] 三维超声心动图；实时显像；肺栓塞

[中图分类号] R542.2[文献标识码] B[文章编号]1673-7210（2011）11（c）-105-02

Evaluation of global right ventricular function in patients with acute pulmonary embolism using Real-time Three-dimensional echocardiography

LIU Huan, CAO Yunxiang, QIAN Dajun

Department of Cardiac Function, the Affiliated Wuxi People′s Hospital of Nanjing Medical University, Jiangsu Province, Wuxi 214023, China

[Abstract] Objective: To explore the value of the right ventricular (RV) global function in patients with acute pulmonary embolism (APE) by using real-time Three-dimensional echocardiography (RT-3DE). Methods: 30 normal controls and 30 patients with APE were studied. And all the three-dimensional echocardiographic datasets were acquired. Then series of RV parameters, namely end diastolic volume (EDV), end systolic volume (ESV), RV ejection fraction (EF) were offline measured by TomTec 4D RV-Analysis software which can also provide the right ventricular volume-time curves (RV-VTC). EDV, ESV, EF, RV peak filling rate (PFR) and RV peak ejection rate (PER) from RT-3DE were investigated in the two groups. Results: Compared with control group, the value of EDV and ESV were larger; EF, PER, PFR were reduced, there were significant differences in the two groups (t=2.490, 2.172, 2.897, 2.894 and 3.042, respectively, all P＜0.05). Conclusion: The RV function in patients with APE is decreased and RT-3DE can evaluate RV volume and global function accurately.

[Key words] Three-dimensional echocardiography; Real-time imaging; Pulmonary embolism

急性肺栓塞（APE）是一种威胁患者生命的常见心血管疾病，其肺动脉高压引起右心室（RV）压力负荷急剧增大，导致右心功能损伤，进一步发展为右心衰竭和全心衰竭[1-2]。研究显示合并右心功能不全的病例90 d死亡率明显提高，多元回归分析提示右室功能不全是APE远期预后的一项独立危险因素和不良预后的早期预警[3]。因此，准确评估APE患者右心功能尤为重要。本文探讨实时三维超声心动图（RT-3DE）在APE患者右心功能检测方面的应用价值。

1 资料与方法

1.1 一般资料

选择2007年12月～2011年6月我院收治的APE患者30例（APE组），男19例，女11例；平均年龄（60.7±10.3）岁。均由临床表现、实验室检查、心电图、X线及肺动脉CT和（或）肺动脉造影证实。根据临床表现及辅助检查等对APE组患者有无合并心血管疾病及其危险因素、呼吸系统疾病、肾脏疾病、糖尿病以及可能引起心脏结构或功能改变的其他疾病进行分类。……