目的:应用应变率探讨不同左心室构型的原发性高血压患者左心室长轴方向应变－应变率成像的变化,及其与EF、FS及二尖瓣血流测量评价左室功能的对照研究。方法:采用M型、二维、多普勒超声及应变率成像技术,测量左室室壁厚度、左室内径、EF、FS,二尖瓣血流频谱E、A及左室平均应变ε,应变率S、e、a。结果:高血压离心性肥厚组EF、FS明显低于对照组,高血压其余各组EF、FS与对照组无统计学差异;收缩期应变率S应变ε在五组间差异均有显著性意义:高血压各组较正常对照组减小(I--Ⅴ呈递减);舒张期应变率e减低、a增高,e/a比值减小,各组间存在统计学差异(Plt;0.05); E/A,e/a结果大体一致。结论:应变率成像为临床提供了一个敏感、简便、可靠的评价原发性高血压患者左室心肌功能的指标。
Objective To investigate surgical treatment and evaluate the curative effect in patients with moderate to severe ischemic mitral regurgitation (IMR). Methods The clinical data of the patients with coronary heart disease complicated with moderate to severe IMR who agreed to receive surgical treatment from June 2014 to June 2019 in our hospital were analyzed retrospectively. The patients were divided into two groups: a coronary artery bypass grafting (CABG) group and a CABG+mitral valve surgery (MVS) group. The preoperative and postoperative clinical data between the two groups were compared. Results Finally 105 patients were collected, including 75 males and 30 females, aged 40-79 (62.70±7.90) years. There were 34 patients in the CABG group, and 71 patients in the CABG+MVS group including 2 patients of mitral valvuloplasty and 29 patients of mitral valve replacement. Among the 105 patients, 5 died during the perioperative period and 2 died in 3 months after operation, all of whom were from the CABG+MVS group. There was no statistical difference in perioperative and postoperative 3-month mortality rate between the two groups (P=0.14). Eighty-seven patients were followed up in the medium and long term. There was no statistical difference in the degree of preoperative mitral insufficiency (MI) (P=0.59) and left atrium diameter (P=0.51) between the two groups, but the degree of postoperative MI in the CABG group was significantly higher than that in the CABG+MVS group (P<0.01). However, the left atrium diameter in the CABG group was significantly smaller than that in the CABG+MVS group (P<0.01). Paired analysis showed that systolic pulmonary artery pressure, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction and MI were significantly improved after operation (P<0.01); left atrium diameter was significantly improved after operation in the CABG group (P<0.01), but there was no statistical difference before and after operation in the CABG+MVS group (P=0.10). Conclusion For patients with moderate to severe IMR, CABG with mitral valve treatment can improve left ventricular remodeling, but can not significantly improve left atrial remodeling. Whether performing mitral valve treatment during CABG should be cautious. CABG alone is a safe and effective scheme for elderly patients with poor physical condition and low life expectancy.