单心动周期实时三维超声评价房间隔缺损患者的右室容积和功能研究

摘要

Objective To investigate the changes of right ventricular(RV) volume and function in patients with atrial septal de-fect(ASD) .Methods 31 patients with ASD-type secundum(ASD group) and 30 age-matched controls(control group) were includ-ed .Single beat real-time three dimensional echocardiography (sbRT3DE) were performed in all to evaluate right ventricular volume and function ,then right venrtricular cardiac output(RVCO) were calculated with heart rate .Further correlative analysis was calcu-lated between right ventricular volume and function parameters of the ASD group and ASD size and the patient′s age .Results Right ventricular end-systolic volume(RVESV) ,right ventricular end-diastolic volume(RVEDV) ,right ventricular stroke volume (RVSV) ,right ventricular ejection fraction(RVEF) ,RVCO of the ASD group were significantly higher than that of control group (P<0 .001) .The maximum diameter of ASD had positive relation with RVESV ,RVEDV ,RVSV ,RVCO(r=0 .55 ,P<0 .01 ;r=0 .61 ,P<0 .01 ;r=0 .63 ,P<0 .01;r=0 .61 ,P<0 .01 ,respectively ) ,and was best correlation with RVSV .But ,there was no signifi-cant correlation between the maximum diameter of ASD and RVEF (r=0 .00 ,P>0 .05) .The patients′age had positive relation with RVESV ,RVEDV ,RVSV(r=0 .53 ,P<0 .01 ;r=0 .48 ,P<0 .01 ;r=0 .41 ,P<0 .01 ,respectively) ,had negtive relation with RVEF (r= -0 .44 ,P<0 .05) ,while there was no significant correlation between the patient′s age and RVCO(r=0 .26 ,P>0 .05) .Conclu-sion sbRT3DE is a fast and accurate new technology in evaluating RV volume and function .Atrial level left-to-right shunt leading to an increase in RV volume ,RV enlargement produces myocardial contractility .RV volume increases with ASD size ,then RV func-tion was enhanced .RV volume increases with patient′s age ,RV function is relatively lower .%目的：探讨房间隔缺损患者右室容积和功能的改变。方法选取继发孔型房间隔缺损患者31例（房缺组）及健康体检者30例（对照组），应用单心动周期实时三维超声测定所有研究对象的右室容积和功能参数，并通过心率计算右心室心输出量（RVCO ）。对房缺组右室容积和功能相关参数与缺损最大径和患者年龄作相关性研究。结果房缺组的右心室收缩末容积（RVESV）、右心室舒张末容积（RVEDV）、右心室每搏量（RVSV），右心室射血分数（RVEF）及 RVCO 均显著高于对照组（P＜0．01）。缺损最大径与RVESV、RVEDV、RVSV及RVCO呈正相关（r＝0．55，P＜0．01；r＝0．61，P＜0．01；r＝0．63，P＜0．01；r＝0．61，P＜0．01），与RVSV相关性最好，而缺损最大径与RVEF没有明显相关性（r＝0．00，P＞0．05）。患者年龄与RVESV、RV-EDV、RVSV呈正相关（r＝0．53，P＜0．01；r＝0．48，P＜0．01；r＝0．41，P＜0．01），与RVEF呈负相关（r＝-0．44，P＜0．05），与RVCO没有明显相关性（r＝0．26，P＞0．05）。结论单心动周期实时三维超声是能够快速、准确测量右室容积和功能的新技术；房间隔缺损由于房水平由左向右分流，右心室容量增多，右心室扩大心肌收缩力增强，心功能增高；缺损越大，分流量越多，右心室容量越大，右心功能越高；年龄越大，分流持续时间延长，右心室容量越大，而右心功能相对减低。