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目的应用实时三维超声心动图(RT-3DE)评估左室射血分数正常的老年高血压患者左心房容积与功能的变化。方法 79例老年原发性高血压患者,其中左室肥厚(LVH)组38例,非左室肥厚(NLVH)组41例,正常对照组28例。常规超声心动图测量左心房径(LAD)、二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),计算E/A值。脉冲组织多普勒测定室间隔二尖瓣环处舒张早期峰值速度(E’),舒张晚期峰值速度(A’),计算E/E’。RT-3DE技术测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左房收缩前容积(LAVp),计算左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)。比较3组间各项检测指标的变化。结果与对照组比较,高血压NLVH组和LVH组的E/E’、LAVmax、LAVp、LAAEF均显著增加(P<0.05);高血压LVH组的LAD、LAVmin显著增加,差异有统计学意义(P<0.05),E/A及LAPEF均显著减低,差异有统计学意义(P<0.05)。结论实时三维超声技术可以评价高血压患者的左心房容积及功能,高血压患者左心房功能障碍在左室肥厚前即已发生,而LVH患者左心房功能及左室舒张功能障碍更为严重。
Objective To evaluate the change of left atrium volume and function in elderly hypertensive patients with normal left ventricular ejection fraction (LVEF) by real-time three-dimensional echocardiography (RT-3DE). Methods A total of 79 elderly patients with essential hypertension were included in this study. Among them, 38 were in LVH group, 41 in non-LVH group and 28 in control group. Conventional echocardiography was used to measure left atrial diameter (LAD), mitral early diastolic flow velocity (E) and late diastolic flow velocity (A), and E / A values were calculated. Pulmonary Tissue Doppler was used to determine the early diastolic peak velocity (E ’) and the late diastolic peak velocity (A’) at the mitral valve annulus. E / E ’was calculated. The LAVmax, LAVmin and LAVp were measured by RT-3DE technique. The left atrium passive ejection fraction (LAPEF), LAAEF (left atrium primary ejection fraction) . The changes of the detection indexes between the three groups were compared. Results Compared with the control group, the levels of E / E ’, LAVmax, LAVp and LAAEF in hypertensive NLVH group and LVH group were significantly increased (P <0.05); LAD and LAVmin in hypertensive LVH group were significantly increased P <0.05), E / A and LAPEF were significantly decreased, the difference was statistically significant (P <0.05). Conclusion Real-time three-dimensional ultrasound can evaluate left atrium volume and function in hypertensive patients. Left atrial dysfunction in hypertensive patients occurs before left ventricular hypertrophy. LVH patients have more severe left atrial function and left ventricular diastolic dysfunction.