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目的利用实时三维超声心动图(RT-3DE)探讨尿毒症血液透析患者左心室机械运动同步性的特征。方法采集左室射血分数(3D-LVEF)>50%的尿毒症患者61例和正常对照组31例实时三维全容积图像。由左心室17节段容积-时间曲线测量左心室16节段、12节段和3个短轴水平(基底水平、乳头肌水平和心尖水平)的同步性参数,同步性参数包括达收缩期最小容积时间标准差的标准化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv1-6-SD%、Tmsv7-12-SD%、Tmsv13-16-SD%)和最大时间差的标准化值(Tmsv16-Dif%、Tmsv12-Dif%、Tmsv1-6-Dif%、Tmsv7-12-Dif%、Tmsv13-16-Dif%)。将61例尿毒症患者分为3组:A组19例,为透析时间≤2年的患者;B组22例,为透析时间>2年~≤4年的患者;C组20例,为透析时间>4年~≤6年的患者,并将参数进行组间对比。结果与正常对照组比较,尿毒症A、B、C 3组左心室16节段、12节段和各短轴水平同步性参数均增大;B组、C组较A组增大;B、C两组组间除Tmsv1-6-Dif%差异有统计学意义,余参数差异无统计学意义。尿毒症组左心室各同步性参数与3D-LVEF间均呈显著负相关。结论 RT-3DE可以早期发现尿毒症血液透析患者左心室整体和各个短轴水平内心肌运动的同步性特征,为临床早期无创准确评估左心室局部收缩功能提供了一种定量、定性的方法。
Objective To investigate the synchronization of left ventricular mechanical motion in uremic hemodialysis patients by real-time three-dimensional echocardiography (RT-3DE). Methods Sixty-one patients with uremia with left ventricular ejection fraction (3D-LVEF)> 50% and 31 normal controls were enrolled in this study. Synchronization parameters of 16 segments, 12 segments and 3 short axis levels (basal level, papillary muscle level and apical level) of the left ventricle were measured from the volume-time curve of the left ventricular 17 segment, and the synchronization parameters included the minimum systolic (Tmsv16-SD%, Tmsv1-6-SD%, Tmsv7-12-SD%, Tmsv13-16-SD%) and the standardized value of the maximum time difference (Tmsv16-Dif% , Tmsv12-Dif%, Tmsv1-6-Dif%, Tmsv7-12-Dif%, Tmsv13-16-Dif%). 61 cases of uremia patients were divided into 3 groups: A group of 19 patients, dialysis time ≤ 2 years; 22 patients in group B, for dialysis time> 2 years to ≤ 4 years of patients; C group of 20 patients for dialysis Time> 4 years ~ 6 years of patients, and the parameters were compared between groups. Results Compared with the normal control group, the horizontal synchrony parameters of 16 segments, 12 segments and each short axis of left ventricle increased in groups A, B and C of uremia; There were significant differences in the Tmsv1-6-Dif% between the two groups, but the difference of the remaining parameters was not statistically significant. There was a significant negative correlation between the left ventricular synchrony parameters and 3D-LVEF in uremia group. Conclusion RT-3DE can early detect the synchronic characteristics of left ventricular motion and myocardial motion within short axis in uremic hemodialysis patients. It provides a quantitative and qualitative method for non-invasive and accurate assessment of local systolic function of left ventricular in early clinical stage.