| 摘要: |
| 摘 要 目的 应用实时三维超声心动图（RT-3DE）技术评价阻塞性睡眠呼吸暂停综合征（OSAS）患者不同左室构型左房结构和功能。方法 经多导睡眠呼吸仪（PSG）监测呼吸暂停指数（AHI）≥5次/h确诊为OSAS的患者121例，次日晨行血压、血糖、血脂及超声心动图检查,依据左室质量指数（LVMI）≥108g/m2?（男）或99g/m2（女）、相对室壁厚度（RWT）≥0.51（男）或0.49（女），分为4组：正常构型（NG）组，向心性重构（CR）组，离心性肥厚（EH）组，向心性肥厚（CH）组。采集OSAS患者心脏全容积图像，QLAB 软件脱机分析，获取左心房容积-时间曲线，得到左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVpre-a)，计算出左房总排空容积（LA TotEV）、总排空分数(LA TotEF) 、被动排空容积(LA PassEV)、被动排空分数(LA PassEF)、主动排空容积(LA ActEV)，主动排空分数(LA ActEF)，比较组间左房结构和功能参数的差异。结果 ①结构参数：与NG组相比，CR、EH和CH组LAVmax、LAVmax/BSA、LAVmin、LAVmin/BSA、LAVpre-A、LAVpre-A/BSA均增加，差异有统计学意义（P＜0.05）；与CR组相比，EH和CH组LAVmax、LAVmax/BSA、LAVmin、LAVmin/BSA、LAVpre-A、LAVpre-A/BSA均增加，差异有统计学意义（P＜0.05）。②储蓄功能参数：与NG组相比，CR、EH和CH组LA TotEV增加，EH和CH组LA ActEF增加，差异有统计学意义（P＜0.05）；与CR相比，EH和CH组LA TotEV增加，CH组LA ActEF增加，差异有统计学意义（P＜0.05）③管道功能参数：与NG组相比，EH和CH组LA PassEV增加，差异有统计学意义（P＜0.05）；与CR相比，EH和CH组LA PassEV增加，差异有统计学意义（P＜0.05）。④助力泵功能参数：与NG组相比，CR、EH和CH组LA ActEV增加，EH和CH组LA ActEF增加，差异有统计学意义（P＜0.05）；与CR相比，CH组LA ActEV和LA ActEF增加，差异有统计学意义（P＜0.05）。结论 ①OSAS患者不同左室几何构型左房结构和功能不同。②CR、EH、CH左房容积较NG组大。③CR组左房储蓄功能、助力泵功能增加，但管道功能无异常；EH及CH组左房储蓄功能、助力泵功能增加，管道功能减低。 |
| 关键词: 超声心动描计术，实时三维 睡眠呼吸暂停，阻塞性 构型，左室 心房功能，左 |
| DOI： |
| 投稿时间：2019-01-09修订日期：2019-02-12 |
| 基金项目:山西省重点研发计划项目（国际科技合作）（201703D421026） |
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| The clinical study on left atrial structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome by real-time three-dimensional Echocardiography |
| wu xiaojuan,wangjian |
| (Department of Medical Imaging, Shanxi Medical University) |
| Abstract: |
| ABSTRACT Objective The aim of the study was to evaluate left atrial (LA) structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome（OSAS）by real-time three-dimensional echocardiography (RT-3DE). Methods 121 patients with habitual snoring were diagnosed as OSAS by polysomnography with apnea hypopnea index(AHI)≥5/h. Blood pressure and general clinical characteristics were collected and echocardiography was done next morning. On the basis of LV mass index?(LVMI)≥?(male)108g/m2 or?99g/m2?(female)?,?relative wall thickness(RWT)≥0.51?(male) or 0.49?(female), patients were divided into 4 groups: normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), concentric hypertrophy (CH). Full volume images at apical four-chamber view were collected. Left atrial volume-time curve，LA maximum volume (LAVmax), LA minimum volume (LAVmin), LA pre-contraction volume (LAVpre-a) were analyzed with QLab workstation. Following parameters including LA total emptying volume (LA TotEV), LA total emptying fraction (LA TotEF), LA passive emptying volume (LA PassEV), LA passive emptying fraction (LA PassEF), LA active emptying volume (LA ActEV) , LA active emptying fraction (LA ActEF) were calculated. Result ① LA structural parameters: compared with NG group, LAVmax、LAVmax/BSA、LAVmin、LAVmin/BSA、LAVpre-A、LAVpre-A/BSA were increased in CR、EH and CH groups（P＜0.05）; compared with CR group, LAVmax、LAVmax/BSA、LAVmin、LAVmin/BSA、LAVpre-A、LAVpre-A/BSA were increased in EH and CH groups（P＜0.05）;②LA reservoir function parameters: compared with NG group, LA TotEV was increased in CR、EH and CH groups（P＜0.05）;compared with CR group, LA TotEV was increased in EH and CH groups（P＜0.05）;③LA conduit function parameters: compared with NG group, LA PassEV was increased in EH and CH groups（P＜0.05）;compared with CR group, LA PassEV was increased in EH and CH groups（P＜0.05）;④LA pump function parameters: compared with NG group, LA TotEV was increased in CR、EH and CH groups, LA ActEF was increased in EH and CH groups（P＜0.05）;compared with CR group, LA TotEV and LA ActEF were increased in CH group（P＜0.05）.Conclusion Different Left ventricular geometric patterns have different LA structure and function in OSAS. In CR、EH and CH groups，LAV was increased. In CR, left atrial reservoir and booster pump were increased , but the conduit function was decreased; In EH and CH, left atrial reservoir and booster pump were increased , but the conduit function was decreased. |
| Key words: Echocardiography, real-time three-dimensional Sleep apnea, obstructive Geometric patterns, left ventricular Atrial function, left |
