组织多普勒Tei指数评价动静脉内瘘术后不同流量负荷患者左室功能的研究
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摘要
目的应用组织多普勒Tei指数评价行动静脉内瘘(AVF)血液透析患者的左室功能,探讨长期不同流量(Qa)负荷状态对左室功能的影响。方法选取行AVF血液透析的患者60例,分为Qa<1000 ml/min、Qa1000～2000 ml/min、Qa>2000 ml/min 3组,分别于术前1周、术后6个月、术后12个月行常规超声心动图检查测量左室射血分数(EF)、短轴缩短分数(FS)、二尖瓣口舒张早、晚期峰值血流速度比值(E/A)、二尖瓣环运动速度比值(Ea/Aa),应用组织多普勒技术测量Tei指数,并对Tei指数与左室功能指标进行相关性分析。结果重复测量主效应分析显示,不同Qa负荷下EF、FS、E/A、Ea/Aa、Tei指数比较差异均有统计学意义(均P<0.001),术后不同时间点对EF、FS、E/A、Ea/Aa、Tei指数的效应均有统计学意义(均P<0.001),不同Qa负荷与术后不同时间点对EF、FS、E/A、Ea/Aa、Tei指数的交互效应均有统计学意义(均P<0.001)。Qa<1000 ml/min组EF、FS、E/A、Ea/Aa、Tei指数术后6个月和术后12个月与术前1周比较差异均无统计学意义,Qa1000～2000 ml/min组Ea/Aa术后6个月和术后12个月与术前1周比较均减低,Tei指数均增高(均P<0.05),Qa>2000 ml/min组EF、FS、E/A、Ea/Aa术后6个月和术后12个月与术前1周比较均减低,Tei指数均增高(均P<0.05)。相关性分析示Tei指数与EF、FS、E/A、Ea/Aa均呈负相关(r=-0.634、-0.622、-0.569、-0.597,均P<0.01)。结论 AVF不同Qa负荷状态会对左室功能造成不同影响,AVF患者应定期进行心脏功能监测;Tei指数是一项综合评价心脏收缩、舒张功能的指标,可用于AVF术后监测心功能。
ObjectiveToevaluate the left ventricular function in hemodialysis patients with arteriovenous fistula(AVF)by tissue Doppler Tei index,and to investigate the effect of long-term different access flow(Qa) loads on left ventricular function.MethodsSixty hemodialysis patients with AVF were enrolled.The patients were divided into Qa<1000 ml/min group,Qa1000～2000 ml/min group and Qa>2000 ml/min group according to the different Qa. Left ventricular function indicators ejection fraction(EF),fractional shortening(FS),early to late diastolic mitral valve flow velocity ratio(E/A),mitral annulus movement velocity ratio(Ea/Aa)were measured by conventional echocardiography one week before,6 months and 12 months after surgery,and Tei index was measured by tissue Doppler technique. The correlation between Tei index and left ventricular function indicators was analyzed.ResultsRepeated measurement variance analysis showed that the effects of different Qa on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001).The effects at different time points on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001). The interaction effects of different access flow and different time on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001).EF,FS,E/A,Ea/Aa,Tei index in Qa<1000 ml/min group at 6 and 12 months after surgery comparing with those before surgery were not statistically significance. Ea/Aa in Qa1000～2000 ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased(both P<0.05).The EF,FS,E/A and Ea/Aa in the Qa>2000 ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased(all P<0.05). Correlation analysis suggested that Tei index was negatively correlated with EF,FS,E/A,Ea/Aa(r=-0.634,-0.622,-0.569,-0.597,all P<0.01).ConclusionAVF with different Qa has different impacts on left ventricular function with time migration.The monitoring of cardiac function should be performed regularly.Tei is a comprehensive index for evaluating cardiac systolic and diastolic function,which can be used as an important basis for monitoring cardiac function after AVF operation.
ObjectiveToevaluate the left ventricular function in hemodialysis patients with arteriovenous fistula(AVF)by tissue Doppler Tei index,and to investigate the effect of long-term different access flow(Qa) loads on left ventricular function.MethodsSixty hemodialysis patients with AVF were enrolled.The patients were divided into Qa<1000 ml/min group,Qa1000～2000 ml/min group and Qa>2000 ml/min group according to the different Qa. Left ventricular function indicators ejection fraction(EF),fractional shortening(FS),early to late diastolic mitral valve flow velocity ratio(E/A),mitral annulus movement velocity ratio(Ea/Aa)were measured by conventional echocardiography one week before,6 months and 12 months after surgery,and Tei index was measured by tissue Doppler technique. The correlation between Tei index and left ventricular function indicators was analyzed.ResultsRepeated measurement variance analysis showed that the effects of different Qa on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001).The effects at different time points on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001). The interaction effects of different access flow and different time on EF,FS,E/A,Ea/Aa,Tei were statistically significant(all P<0.001).EF,FS,E/A,Ea/Aa,Tei index in Qa<1000 ml/min group at 6 and 12 months after surgery comparing with those before surgery were not statistically significance. Ea/Aa in Qa1000～2000 ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased(both P<0.05).The EF,FS,E/A and Ea/Aa in the Qa>2000 ml/min group at 6 and 12 months after surgery decreased comparing with before surgery and the Tei index increased(all P<0.05). Correlation analysis suggested that Tei index was negatively correlated with EF,FS,E/A,Ea/Aa(r=-0.634,-0.622,-0.569,-0.597,all P<0.01).ConclusionAVF with different Qa has different impacts on left ventricular function with time migration.The monitoring of cardiac function should be performed regularly.Tei is a comprehensive index for evaluating cardiac systolic and diastolic function,which can be used as an important basis for monitoring cardiac function after AVF operation.
引文
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[2]梅长林,叶朝阳,戎殳.实用透析手册[M].2版.北京:人民卫生出版社,2013:343-344.
[3]侯永志,德吉,李震宇.组织多普勒Tei指数评价血压正常高值者左室功能[J].临床超声医学杂志,2017,19(12):844-847.
[4]Tessitore N,Bedogna V,Verlato G,et al.Clinical access assessment[J].Vase Access,2014,15(Suppl 7):20-27.
[5]陈迈.组织多普勒测量Tei指数对糖尿病患者左室功能的评价作用(附90例报告)[J].福建医药杂志,2012,34(3):121-123.
[6]Santoro D.Vascular access for hemodialysis and cardiovascular complications[J].Minerva Urologica E Nefrologica,2010,62(1):81-85.
[7]Rao N,worthley M,Disney P,et al.Dramatic improvement in decompensated right heart failure due to severe tricuspid regurgitation following ligation of arteriovenous fistula in a renal transplant recipient[J].Semin Dial,2014,27(2):24-26.
[8]吴其夏,余应年,卢建.病理生理学[M].北京:中国协和医科大学出版社,2003:472.
[9]Sivanandam S,Wey A,St LJ.Intraoperative transesophageal echocardiographic assessment of left ventricular Tei index in congenital heart disease[J].Ann Cardiac Anaesth,2015,18(2):198-201.