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目的了解继发性肺高压(pulmonary hypertension,PH)对右心室整体及局部应变(strain,S)的影响。方法正常组选健康成年人20例,选取在我院心外科拟行手术治疗的继发性PH患者19例作为PH组,使用Philip ie33超声诊断仪,在心尖四腔心切面采集右心室的组织多普勒显像图像,将右心室侧壁及室间隔分为右心室基底段、右心室心尖段、室间隔心尖段和室间隔基底段共4个节段,分别测量右心室各节段的s值及右室平均值。结果组内各节段s值的差异均有统计学意义(正常组及PH组的P值均<0．01)。与正常组相比,PH组的RV基底段S及RV平均S降低[(-7．43±4．94)％比(-21．49±8．77)％, P<0．01;(-9．63±2．76)％比(-13．84±3．99)％, P<0．01]。正常组中,70％的患者右心室基底段S值最高:在PH组中,68％的患者右心室心尖段S值最高:但PH组右心室心尖段的s值仍低于正常组的右心室基底段S值(P<0．05)。PH组的肺动脉收缩压与右心室基底段的S值及右心室平均S值均差异无统计学意义(P>0．05)。PH组的心率为(87．9±12．3)次/min,明显高于正常组的[(68．8±1．7)次／min,P<0．01],校正心率(测值／R-R间期的平方根)后,两组间各节段S值及右心室平均S值达峰时间的差异亦无统计学意义(P值均>0．05)。结论PH时右心室平均S值减低,主要是由于右心室侧壁基底段的S减低所致;而右心室应变的同步性不受影响。
Objective To investigate the effect of pulmonary hypertension (PH) on global and local strain (S) of right ventricle. Methods Twenty healthy adults were enrolled in this study. Nineteen patients with secondary PH who were surgically treated undergoing cardiac surgery in our hospital were selected as PH group. The tissue of right ventricle Doppler imaging images of the right ventricular wall and interventricular septum is divided into basal segment of the right ventricle, right apex apical segment, interventricular septal apex and ventricular septal base segment of a total of four segments were measured in each segment of the right ventricular s Value and right ventricular averages. Results There were significant differences in s between the two groups (P <0.01 for both normal group and PH group). Compared with the normal group, the average S of the RV basal segment S and RV in the PH group decreased by (-7.43 ± 4.94)% (-21.49 ± 8.77)%, P <0.01; ( -9.63 ± 2.76)% (-13.84 ± 3.99)%, P <0.01]. In the normal group, the S value of the basal segment of the right ventricle was the highest in 70% of the patients: in the PH group, 68% of the patients had the highest S value in the right ventricular apical segment: in the PH group, the s value of the right ventricular apical segment was still lower than that in the normal group Ventricular basal segment S value (P <0.05). The PH value of pulmonary artery systolic pressure in the PH group and the right ventricular basement S value and the average right ventricular S value was no significant difference (P> 0.05). The heart rate of PH group was (87.9 ± 12.3) times / min, which was significantly higher than that of the normal group [(68.8 ± 1.7) times / min, P <0.01) / RR interval of square root), the two groups between the S value and the right ventricular mean S value peak time difference was not statistically significant (P values> 0.05). Conclusion The decrease of average S value of right ventricle at PH is mainly due to the decrease of S in the basal segment of the right ventricular wall, while the synchronization of right ventricular strain is not affected.