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目的应用超声二维斑点追踪成像技术(STI)探讨尿毒症患者的左心室旋转及扭转运动特征,并评价心肌同步性运动。方法尿毒症患者30例,正常对照组31例。经胸采集并存储标准左心室基底部及心尖部短轴二维图像,运用EchoPAC超声工作站进行脱机分析。计算左心室心尖部旋转角度及达峰时间、心底部旋转角度及达峰时间、左心室峰值扭转角度及达峰时间、主动脉瓣关闭时间点扭转角度、解旋率,并比较两组间各参数的差异。结果①尿毒症患者左心室心尖部旋转角度峰值(Prot)、峰值扭转角度(Ptw)、主动脉瓣关闭时间点扭转角度(AVCtw)及解旋率(UntwR)较正常对照组明显减低,差异均有统计学意义(P<0.001)。②尿毒症患者心尖部旋转角度达峰时间、扭转角度达峰时间均明显延迟于主动脉瓣关闭时间,而心底部旋转角度达峰时间早于主动脉瓣关闭时间,差异均有统计学意义(P<0.05)。③尿毒症患者Ptw与左心室射血分数(LVEF)、收缩末期容积(LVESV)、舒张末期容积(LVEDV)及心尖部旋转速度峰值(PTVap)高度相关(P<0.05)。结论STI技术可准确、无创地评价左心室旋转及扭转运动,并能从旋转运动的角度评估心肌运动的同步性。
Objective To investigate the characteristics of left ventricular rotation and torsion in patients with uremia by two-dimensional speckle tracking imaging (STI) and to evaluate myocardial synchronous motion. Methods uremic patients 30 cases, 31 cases of normal control group. Transthoracic acquisition and storage of standard left ventricular base and apex short axis two-dimensional images, the use of EchoPAC ultrasound workstation for offline analysis. Left ventricular apex rotation angle and peak time, the bottom of the heart rotation angle and peak time, left ventricular peak torsion angle and peak time, aortic valve closure time point of torsion angle, spin-off rate, and compared between the two groups Differences in parameters. Results ① The peak (Prot), peak twisting angle (Ptw), AVCtw and UntwR of left ventricular apex in uremic patients were significantly lower than those in normal controls There was statistical significance (P <0.001). (2) The peak time of apical rotation and peak time of torsion in uremia patients were significantly delayed than the aortic valve closure time, while the peak rotation time of heart bottom was earlier than the closure time of aortic valve, the differences were statistically significant ( P <0.05). (3) Ptw in uremic patients was significantly correlated with left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), end-diastolic volume (LVEDV) and peak apical velocity (PTVap) Conclusions The STI technique can accurately and noninvasively evaluate left ventricular rotation and torsion, and evaluate the synchrony of myocardial motion from the perspective of rotational movement.