【摘要】 目的 采用组织多普勒成像（TDI）检测右室心尖部起搏（RVAP）、右室流出道起搏（RVOTP）对于左室同步性的影响与比较。 方法 2008年3月-2010年3月20例安置RVAP患者及20例安置RVOTP患者术后3个月行TDI检测，将左室12节段收缩达峰时间的标准差（TS-SD）、6个基底段收缩达峰时间差值、左室12个节段中任意两个节段收缩达峰时间最大差值作为同步化参数。 结果 TDI结果显示，两组之间同步性参数比较，有统计学意义（Plt;0.01）。 结论 RVAP会导致左室内收缩不同步，TDI技术可以准确评价左室收缩同步性。【Abstract】 Objective To explore the impact of right ventricular apex pacing (RVAP) and right ventricular outflow tract pace-making (RVOTP) on left ventricular systolic synchronization (LVSS) via tissue Doppler imaging (TDI). Methods A total of 20 patients with RVAP and 20 patients with RVOTP from March 2008 to March 2010 were collected. TDI detection was performed on all the patients three months after the operation. Synchronizing parameters included TS-SD of 12 regional contractions of left ventricle, 6 TS difference of basal segment, and maximum difference of TS in 12 regional contractions of left ventricle. Results The results of TDI showed significant difference in synchronizing parameters between RVAP and RVOTP (Plt;0.01). Conclusion RVAP may lead to un-synchronization of the left systole. TDI can evaluate LVSS accurately.
Abstract： 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 milrinone administration were significantly higher than those before dopamine and milrinone 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 administration （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 assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.