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中华医学超声杂志(电子版) ›› 2016, Vol. 13 ›› Issue (05) : 366 -370. doi: 10.3877/cma.j.jssn.2095-5820.2016.05.009

所属专题: 文献

心血管超声影像学

超声瞬时波强技术评价尿毒症患者心脏-动脉整体功能
郑小艳1,(), 顾鹏1, 唐盈1, 李玲1, 贺鹏1   
  1. 1. 637000 南充,川北医学院附属医院超声科
  • 收稿日期:2015-07-03 出版日期:2016-05-01
  • 通信作者: 郑小艳

Evaluation of cardiovascular systemic function in uraemia patients by wave intensity

Xiaoyan Zheng1,(), Peng Gu1, Ying Tang1, Ling Li1, Peng He1   

  1. 1. Department of Ultrasound, Affilited Hospital of North Sichuan Medical College, Nanchong 637000, China
  • Received:2015-07-03 Published:2016-05-01
  • Corresponding author: Xiaoyan Zheng
  • About author:
    Corresponding author: Zheng Xiaoyan, Email:
引用本文:

郑小艳, 顾鹏, 唐盈, 李玲, 贺鹏. 超声瞬时波强技术评价尿毒症患者心脏-动脉整体功能[J/OL]. 中华医学超声杂志(电子版), 2016, 13(05): 366-370.

Xiaoyan Zheng, Peng Gu, Ying Tang, Ling Li, Peng He. Evaluation of cardiovascular systemic function in uraemia patients by wave intensity[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(05): 366-370.

目的

应用瞬时波强(WI)技术评价尿毒症患者早期心脏-动脉系统整体功能的临床研究价值。

方法

选取2014年1月至6月川北医学院附属医院肾内科尿毒症患者(尿毒症组)30例和健康体检中心健康对照组(健康组)30名,应用WI技术分别评价心脏功能、动脉弹性参数,心脏参数包括瞬时加速度波强峰值(W1),瞬时减速度波强峰值(W2),负向波面积(NA)、心电图R波至W1波顶点时间(R-W1)、W1与W2的时间间隔(W1-W2),动脉弹性参数包括血管僵硬度指数(β),血管压力应变弹性系数(Ερ)、脉搏波传导速度(PWVβ)、血管顺应性(AC)、脉搏波反射增强(AI)等。同时应用M型超声于左心室长轴切面测量左心室舒张期直径(LVDd)、室间隔厚度(IVS)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF),计算左心室心肌质量指数(LVMI)。采用独立样本t检验比较尿毒症组和对照组多项WI曲线参数的变化情况。

结果

尿毒症组与健康对照组比较,尿毒症组LVDd、LVPWT、LVMI、W1、W2、NA、β、Ερ、PWVβ参数的测值均升高[(52.23±6.25)mm vs(44.20±2.20)mm,(10.67±1.45)mm vs (8.90±1.06)mm,(177034.05±44729.42)g/m2 vs (97542.50±15278.82)g/m2,(15.14±8.76)mmHg?m/s3 vs (6.75±4.13)mmHg?m/s3,(3.55±2.92)mmHg?m/s3 vs (1.53±1.00)mmHg?m/s3,(78.28±58.08) mmHg?m/s2 vs (41.10±24.47)mmHg?m/s2,9.35±4.13 vs 5.98±1.53,(146.66±74.06) kPa vs(75.72±19.63)kPa,(7.16±1.60)m/s vs (5.41±0.66)m/s,(1 mmHg=0.133 kPa)],而尿毒症组较健康对照组W1-W2降低[(237.03±23.72)ms vs (278.41±50.94)ms],差异均有统计学意义(t值分别为6.638、5.393、9.211、4.900、3.703、3.274、4.334、5.237、5.718、-4.165,P值均<0.05),与健康对照组比较,尿毒症组R-W1、AC降低,IVS、AI升高[(102.28±13.98)ms vs (113.69±32.71)ms、(0.86±0.37)mm2/ kPa vs (0.88±0.23)mm2/ kPa、(11.30±1.88)mm vs (8.97±1.40)mm、15.13±10.85 vs 15.08±28.54],但差异均无统计学意义(t值分别为-1.814、-0.251、5.453、0.010,P值均>0.05)。

结论

WI技术可无创评价尿毒症患者早期心血管功能、外周阻力,对尿毒症的进展及治疗提供重要的临床信息。

Objective

To investigate the clinical value of wave intensity technique in evaluating cardiovascular system function in uraemia patients.

Methods

Thirty patients with uraemia (uraemia group) in Renal Department of Internal Medicine and 30 healthy individuals (normal control group) in Health examination center underwent examination by wave intensity in this study in Affiliated Hospital of North Sichuan Medical College from January 2014 to June. Cardiac function and arterial elasticity parameters were evaluated by this technology. The following heart parameters were obtained, including instantaneous acceleration wave intensity (W1), instantaneous deceleration wave intensity (W2), negative wave area (NA), the time between electrocardiogram R wave apex and W1 wave apex (R-W1) and internal time between W1-W2 wave (W1-W2). And the arterial elasticity parameters were stiffness parameter (β), elastic coefficient (Ερ), pulse wave velocity (PWVβ), compliance (AC) and argumentation index (AI). At the same time LVDd, IVS, LVPWT and LVEF were measured by M-mode ultrasonography in left ventricular long-axis view. KVMI was calculated. Independent samples t-test was used to compare the changes of WI curve parameters in uraemia group and normal control group.

Results

In uraemia group LVDd, LVPWT, LVMI, W1, W2, NA, β, Ερ and PWVβ were significantly higher than those in the normal control group [(52.23±6.25) mm vs (44.20±2.20) mm, (10.67±1.45) mm vs (8.90±1.06) mm, (177034.05±44729.42) g/m2 vs (97542.50±15278.82) g/m2, (15.14±8.76) mmHg?m/s3 vs (6.75±4.13) mmHg?m/s3, (1 mmHg=0.133 kPa), (3.55±2.92) mmHg?m/s3 vs (1.53±1.00) mmHg?m/s3, (78.28±58.08) mmHg?m/s2 vs (41.10±24.47) mmHg?m/s2, 9.35±4.13 vs 5.98±1.53, (146.66±74.06) kPa vs (75.72±19.63) kPa, (7.16±1.60) m/s vs (5.41±0.66) m/s, (t=6.638, 5.393, 9.211, 4.900, 3.703, 3.274, 4.334, 5.237, 5.718, all P<0.05)], but W1-W2 was markedly decreased [(237.03±23.72) ms vs (278±50.94) ms, t=-4.165, P<0.05)]. However, there were no significant differences between two groups for R-W1, AC, IVS, AI [(102.28±13.98) ms vs (113.69±32.71) ms, (0.86±0.37) mm2/kPa vs (0.88±0.23) mm2/kPa, (11.30±1.88) mm vs (8.97±1.40) mm, 15.13±10.85 vs 15.08±28.54, t=-1.814, -0.251, 5.453, 0.010, all P>0.05].

Conclusion

Wave intensity technique can noninvasively detect cardiac function, peripheral resistance, as well as elasticity of artery, and can also provide important clinical information for progress and intervention treatment of uraemia.

图2 尿毒症患者瞬时波强技术显示报告界面图。红色曲线为压力曲线,蓝色曲线为速度曲线,黄色曲线为WI曲线,绿色曲线为ECG曲线,W1为WI曲线中第一个尖锐的正向波峰,NA为WI曲线中负向峰,W2为WI曲线中第二个较低平的正向峰,R-W1为心电图上的R波与W1曲线顶点间的时间,W1-W2为W1曲线顶点与W2曲线顶点间的时间
表1 尿毒症患者组与健康对照组一般资料比较(±s
表2 尿毒症患者组与健康对照组WI参数比较(±s
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