| 摘要: |
| 目的 应用组织多普勒Tei指数评价经动静脉内瘘(AVF)血液透析患者左室功能,探讨长期不同流量负荷状态对左室功能的影响。方法 采用前瞻性单盲病例对照方法,选取动静脉内瘘血液透析患者60例,根据动静脉内瘘血流量(Qa)分为Qa<1000ml/min、Qa1000～2000ml/min、Qa>2000ml/min三组,分别于术前1周、术后6个月、术后12个月进行常规超声心动图左室功能的检查,并运用组织多普勒技术测量Tei指数,将Tei指数和常规左室功能指标进行相关性分析。结果 重复测量分析发现,不同流量负荷组之间EF、FS、E/A、Ea/Aa、Tei指数的效应有统计学意义(均P<0.001),术后不同时间点对EF、FS、E/A、Ea/Aa、Tei指数的效应有统计学意义(均P<0.001),不同流量负荷与术后不同时间点的交互效应有统计学意义(均P<0.001)。Qa<1000ml/min组EF、FS、E/A、Ea/Aa、Tei指数术后6个月、12个月与术前比较均无统计学意义(P>0.05),Qa1000～2000ml/min组Ea/Aa术后6个月、12个月与术前比较减低,Tei指数增高(P<0.05),Qa>2000ml/min组EF、FS、E/A、Ea/Aa术后6个月、12个月与术前比较减低,Tei指数增高(P<0.05)。相关性分析提示Tei指数与射血分数(EF),短轴缩短率(FS),二尖瓣口血流速度比值(E/A),二尖瓣环运动速度比值(Ea/Aa)呈负相关(r=-0.634、-0.622、-0.569、-0.597,P<0.01)。结论 动静脉内瘘不同流量负荷状态随时间迁移对左室功能造成不同影响,应对动静脉内瘘患者定期进行心脏功能监测,Tei指数是一项综合评价心脏收缩、舒张功能的指标,可作为AVF术后心功能监测的一项重要依据。 |
| 关键词: 组织多普勒 Tei指数 动静脉内瘘 心室功能,左 |
| DOI： |
| 投稿时间：2018-09-07修订日期：2018-10-10 |
| 基金项目: |
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| Tei index measured by tissue Doppler imaging in evaluating left ventricular function in patients with different access flow after arteriovenous fistula operation |
| CHEN Mai |
| (Medical imaging Department,Fujian Health College Affiliated to Fujian Provincial Organs Hospital) |
| Abstract: |
| Objective Tei index measured by tissue Doppler imaging was used to evaluate left ventricular function in patients with arteriovenous fistula (AVF) hemodialysis and to investigate the effect of long-term different flow loads on left ventricular function.Methods A prospective,single-blind,case-control study was conducted.Sixty patients with arteriovenous fistula were enralled.The patients were divided into Qa < 1000 ml/min group, Qa1000 ~ 2000ml/min group, and Qa > 2000ml/min group according to the different access flow (Qa) .Left ventricular function indicators and Tei index were measured one week before , 6 months and 12 months after surgery.The correlation between Tei index and left ventricular function indicators was analyzed. Results Repeated measurement variance analysis showed that the effects of different access flow on EF、FS、E/A、Ea/Aa、Tei were statistically significant (all P < 0.001).The effect at different time points on EF、FS、E/A、Ea/Aa、Tei were statistically significant (all P < 0.001). The interaction effects of different access flow and different time on EF、FS、E/A、Ea/Aa、Tei were statistically significant (all P < 0.001).EF、FS、E/A、Ea/Aa、Tei index in Qa < 1000 ml/min group at 6 and 12 months after surgery comparing with before surgery were not statistical significance (P > 0.05), Ea/Aa in Qa1000 ~ 2000ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased (P<0.05).The EF, FS, E/A and Ea/Aa in the Qa>2000ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased (P<0.05). Correlation analysis suggested that Tei index was negatively correlated with ejection fraction (EF), fractional shortening(FS), mitral valve flow velocity ratio (E/A), mitral annulus movement velocity ratio (Ea/Aa).(r=-0.634、-0.622、-0.569、-0.597 respectively，all P<0.01）.Conclusion Arteriovenous fistula with different flow load has different impacts on left ventricular function with time migration. The monitoring of cardiac function should be performed regularly.Tei is a comprehensive index for evaluating cardiac systolic and diastolic function, which can be used as an important basis for monitoring cardiac function after AVF operation. |
| Key words: Tissue Doppler Tei index Arteriovenous fistula Ventricular function,left |
