张秉宜 郭瑞强 周青 平杰 张玲 章晓锋

[摘要] 目的 應用实时三平面（RT-3PE）自动功能成像技术（AFI）评价由单次透析所致的前负荷降低对尿毒症患者左室纵向收缩功能的即刻影响。 方法 选取2013年12月～2017年3月在武汉大学人民医院及三峡大学人民医院进行常规透析的尿毒症患者31例。应用RT-3PE AFI实时获取尿毒症患者透析前、后左室收缩期纵向峰值应变（PSLS）及牛眼图，比较透析前、后上述指标的变化。 结果 与透析前比较，透析后左心室射血分数（LVEF）无显著改变（P > 0.05），透析后左心室整体PSLS的平均值显著降低（P < 0.05）。节段性分析显示，透析后局部PSLS仅在中间段出现显著降低（P < 0.01），而在心尖段及基底段均未出现显著改变（均P > 0.05）。透析后左室整体PSLS与LVEF呈显著负相关（r=-0.78，P < 0.01），与Sm亦呈显著负相关（r=-0.50，P < 0.05）；左室整体PSLS变化值与透析液量呈显著正相关（r=0.63，P < 0.05）。 结论 由AFI分析测得的PSLS表明，应用整体PSLS可以准确评价尿毒症患者的左室纵向收缩功能。单次透析能在不改变左室整体收缩功能的情况下，通过降低前负荷影响左室纵向收缩功能，且仅在中间段影响显著。应用PSLS评价尿毒症左室收缩功能时应注意患者的前负荷状态。

[关键词] 超声心动描技术；尿毒症；透析；收缩功能；实时三平面

[中图分类号] R445.3 [文献标识码] A [文章编号] 1673-7210（2018）04（a）-0122-05

[Abstract] Objective To assess the immediate impact of preload reduction caused by single hemodialysis on left ventricular longitudinal systolic function in uremic patients with real-time three plane （real-time three-plane， RT-3PE） automatic functional imaging （AFI） technology. Methods Thirty-one patients with uremia were selected who were underwent routine hemodialysis in People′s Hospital of China Three Gorges University and Renmin Hospital of Wuhan University from December 2013 to March 2017. Left ventricular peak systolic longitudinal strain （PSLS） and bovine eye diagram were detected by using RT-3PE AFI technology before and after routine hemodialysis immediately. The change of indicators was compared before and after routine hemodialysis. Results Compared with pre-hemodialysis， post- hemodialysis the LVEF values had no statistically significant changed （P > 0.05）， the average values of left ventricular whole PSLS were significantly reduced （P < 0.05）. Segmental analysis showed that， the values of local PSLS only appeared in the middle period decreased significantly after hemodialysis （P < 0.01）. There was no significant change in the apex section and basal segment （average P > 0.05）. After hemodialysis， left ventricular overall PSLS and LVEF was significantly negative correlated （r = -0.78， P < 0.01）， and Sm also showed significant negative correlation （r = -0.50， P < 0.50）. While left ventricular overall PSLS and dialysate volume was significantly positive correlated （r = 0.63， P < 0.05）. Conclusion As showing by the results of PSLS measured by AFI analysis， application of left ventricular PSLS can accurately evaluate left ventricular longitudinal contraction function in patients with uremia. Under the condition of no changing the whole systolic function of left ventricular， single dialysis can affect the left ventricular longitudinal systolic function by reducing preload， significant effects change only appeared in the middle section. When using PSLS assessment of left ventricular systolic function in uremia patients， doctors should pay attention to the state of preload.

[Key words] Echocardiography； Uremia； Hemodialysis； Systolic function； Real-time three-plane

收缩期纵向峰值应变（peak systolic longitudinal strain，PSLS）是一种由二维斑点追踪成像技术（two dimensional speckle tracking image，2D-STI）测得的反映左室纵向收缩功能的新指标。使用该指标能更好地理解左室射血分数正常心衰患者的病理生理学基础[1-4]。近年来随着自动功能成像技术（automated function imaging，AFI）的出现，使得测量左室纵向功能变得更加方便、快捷。AFI能提供左室纵向应变的节段性分布牛眼图，从牛眼图中我们可以获取任一节段心肌的局部纵向应变值。应用实时三平面（real-time three-plane，RT-3PE）技术即在同一时相显示心尖两腔、三腔及四腔三个运动切面，将RT-3PE显像技术与AFI相结合，可迅速得出左室17个节段的应变牛眼图，使得分析准确率更高。目前对于由透析所致急性前负荷减少对尿毒症患者左室纵向收缩功能产生何种影响来说尚存在争议。本研究目的旨在使用RT-3PE AFI（牛眼图）的方法探讨由透析所致前负荷降低对尿毒症患者左室纵向收缩功能产生何种影响。