摘要
目的利用组织多普勒应变率技术评估心瓣膜置换术患者使用小剂量多巴胺、米力农对其左心室收缩及舒张功能的影响。方法选择2011年3～5月四川大学华西医院择期行心瓣膜置换术患者共40例,将其随机分为米力农组(20例)和多巴胺组(20例),于麻醉诱导后、体外循环前测量两组患者左心室射血分数(LVEF),应用组织多普勒应变率技术测定四腔心切面左心室侧壁、间壁的组织,并对多普勒参数进行比较。结果两组患者LVEF、左心室舒张早期和舒张晚期血流比值(E/A)、左心室舒张早期血流和舒张早期心肌运动峰值的比值(E/Et)给药前后差异有统计学意义(P<0.05);米力农组有4个节段收缩期峰值速度(Vs),1个节段舒张早期峰值速度(Ve),4个节段舒张晚期峰值速度(Va),3个节段Ve/Va比值,2个节段收缩期峰值应变率(SRs),2个节段舒张晚期峰值应变率(SRa),3个节段舒张早期峰值应变率(SRe)/SRa比值高于给药前(P<0.05);多巴胺组有4个节段Vs,1个节段Ve,4个节段Va,1个节段Ve/Va比值,2个节段SRs,1个节段SRe,1个节段SRa,1个节段SRe/SRa比值高于给药前(P<0.05)。两组间比较,给药后米力农组有2个节段Vs,4个节段Va,1个节段SRe,1个节段SRa,2个节段Ve/Va比值,2个节段SRe/SRa比值高于多巴胺组(P<0.05);其中1个节段Vs,2个节段SRs低于多巴胺组,E/A比值给药10 min时,E/Et比值给药20 min时低于多巴胺组。结论运用组织多普勒应变率技术评估米力农、多巴胺均能改善心瓣膜置换术患者围术期左心室收缩功能,其中米力农对左心室长轴舒张功能的改善较多巴胺明显。
Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup, left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view, which was compared with Doppler parameters. Results LVEF, ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow, ratio of mitral inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P 〈 0. 05）. In the milrinone group, 4 segments systolic peak velocity （Vs）, 1 segment early diastolic peak velocity （Ve）, 4 segments late diastolic peak velocity （Va）, 3 segments Ve/Va ratio, 2 segments systolic peak strain rate （SRs）, 2 segments late diastolic peak strain rate （SRa）, and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and rnilrinone administration were significantly higher than those before dopamine and miMnone administration （P 〈 0. 05）. In the dopamine group, 4 segments systolic peak velocity （Vs）, 1 segment Ve, 4 segments Va, 1 segment Ve/Va ratio, 2 segments SRs, 1 segment SRe, 1 segment SRa, and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone adminis- tration （P 〈 0.05）. To compare the milrione group and dopamine group after medication administration, 2 segments Vs,4 segments Va, 1 segment SRe, 1 segment SRa, 2 segments Ve/Va ratio, and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P〈0.05）, and 1 segment Vs, two segments SRs of the milrione group were significantly lower than those of the dopamine group （P〈0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement as- sessed by tissue Doppler strain rate imaging, while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.
出处
《中国胸心血管外科临床杂志》
CAS
2013年第1期43-48,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
组织多普勒应变率成像
左心室长轴
心瓣膜置换术
米力农
多巴胺
Tissue Doppler strain rate imaging
Long axis of the left ventricle
Heart valve replacement
Milrinone
Dopamine
