挤压伤后心室壁运动状态与整体功能转归的临床研究
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摘要
目的应用心脏超声技术评估挤压伤伤员心室壁运动状态及整体功能的变化。方法地震挤压伤伤员37例,男性21例,女性16例,应用多功能心脏超声技术对抗心衰治疗前后心室壁运动状态及心脏整体功能变化进行综合评估。结果治疗前左室室壁运动幅度明显减弱,同时伴有短轴切面左室壁局部或较大范围的向心性收缩与离心性舒张呈现不协调状态,甚至呈现左室壁的矛盾运动。治疗1个月后,伤员心室壁运动协调状态明显,左室射血分数(EF)及左室周径缩短率(FS)等指标均明显改善(P<0.01)。治疗前伤员心脏整体收缩功能指标(EF、FS、△T及CO)及舒张功能指标(PFVE、PFVA、PFVE/PFVA及PFR)测值均显著降低,治疗后上述指标明显改善(P<0.01),恢复到对照组水平。结论挤压伤可致心肌组织继发损伤,多功能心脏超声技术能客观、及时评估挤压伤后心脏继发受损的情况。
Objective To evaluate the changes in the ventricular wall motion state and the whole cardiac function after crush injury by cardiac ultrasound technology.Methods There were thirty seven cases of crush injury after earthquake with 21 male ones and 16 female ones.Multifunctional cardiac ultrasound technology was used to comprehensively evaluate the ventricular wall motion state and changes of the whole cardiac function before and after anti-heart failure.Results The amplitude of left ventricular wall motion significantly weakened before the treatment.At the same time incongruous state of local or wide ranging centripedal contraction and centrifugal relaxation occurred in the short axis section of the left ventricular wall,and even paradoxical motion of the left ventricular wall occurred.One month after the treatment,the concordant state of the patients' ventricular motion was obvious,and the parameters such as the left ventricular ejection fraction(EF),the left ventricular fractional shortening(FS),etc,were significantly improved(P<0.01).Before the treatment,the cardiac whole contraction function parameters such as EF,FS,△T,and CO and diastolic function parameters such as PFVE,PFVA,PFVE/PFVA,and PFR all decreased significantly,but after the treatment,all of those parameters were improved(P<0.01).Conclusion Secondary injury of cardiac muscle tissues may be caused by crush injury.The multifunctional echocardiography can objectively and promptly evaluate the secondary cardiac damage caused by crush injury.
Objective To evaluate the changes in the ventricular wall motion state and the whole cardiac function after crush injury by cardiac ultrasound technology.Methods There were thirty seven cases of crush injury after earthquake with 21 male ones and 16 female ones.Multifunctional cardiac ultrasound technology was used to comprehensively evaluate the ventricular wall motion state and changes of the whole cardiac function before and after anti-heart failure.Results The amplitude of left ventricular wall motion significantly weakened before the treatment.At the same time incongruous state of local or wide ranging centripedal contraction and centrifugal relaxation occurred in the short axis section of the left ventricular wall,and even paradoxical motion of the left ventricular wall occurred.One month after the treatment,the concordant state of the patients' ventricular motion was obvious,and the parameters such as the left ventricular ejection fraction(EF),the left ventricular fractional shortening(FS),etc,were significantly improved(P<0.01).Before the treatment,the cardiac whole contraction function parameters such as EF,FS,△T,and CO and diastolic function parameters such as PFVE,PFVA,PFVE/PFVA,and PFR all decreased significantly,but after the treatment,all of those parameters were improved(P<0.01).Conclusion Secondary injury of cardiac muscle tissues may be caused by crush injury.The multifunctional echocardiography can objectively and promptly evaluate the secondary cardiac damage caused by crush injury.
引文
(1)徐如祥.地震灾害医学——汶川特大地震救援回顾与经验总结[M].北京:人民军医出版社,2009:82-133.
(2)Sahin N H,Batigun A D,Yilmaz B.Debriefing with teachers afterthe Marmara earthquake:an evaluation study[J].Disasters,2009,33(4):747-761.
(3)李运明,曹文君,陈长生.不等距重复测量设计方差分析用SAS和SPSS实现的对比[J].中国卫生统计,2007,24(4):352-356.
(4)刘水平,陈玉川.严重挤压伤大鼠早期心脏损伤的某些发病机制的探讨[J].中国病理生理杂志,2002,18(6):676-677.
(5)Huang Y S,Yang Z C,Yan B G,et al.Pathogenesis of earlycardiac myocyte damage after crush injury[J].J Trauma,1999,46(3):428-432.
(6)郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
(7)赖小今,郭进春,邓旦,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].解放军医学杂志,2012,37(7):699-701.
(8)赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588.
(9)赖小今,熊杰,胡宗海,等.应变率成像对家兔挤压伤后心肌受损评价的实验研究[J].中华超声影像学杂志,2013,22(1):74-77.
(10)周永昌,郭万学.超声医学[M].5版.北京:科学技术文献出版社,2006:314-462.
(2)Sahin N H,Batigun A D,Yilmaz B.Debriefing with teachers afterthe Marmara earthquake:an evaluation study[J].Disasters,2009,33(4):747-761.
(3)李运明,曹文君,陈长生.不等距重复测量设计方差分析用SAS和SPSS实现的对比[J].中国卫生统计,2007,24(4):352-356.
(4)刘水平,陈玉川.严重挤压伤大鼠早期心脏损伤的某些发病机制的探讨[J].中国病理生理杂志,2002,18(6):676-677.
(5)Huang Y S,Yang Z C,Yan B G,et al.Pathogenesis of earlycardiac myocyte damage after crush injury[J].J Trauma,1999,46(3):428-432.
(6)郭进春,赖小今,廖明松,等.家兔严重挤压伤后心肌组织继发损伤的实验研究[J].解放军医学杂志,2011,36(11):1233-1236.
(7)赖小今,郭进春,邓旦,等.家兔挤压伤后心脏整体功能与心肌超微结构的变化[J].解放军医学杂志,2012,37(7):699-701.
(8)赖小今,廖明松,郭进春,等.家兔挤压伤后心脏节段旋转功能评价的实验研究[J].西南国防医药,2012,22(6):585-588.
(9)赖小今,熊杰,胡宗海,等.应变率成像对家兔挤压伤后心肌受损评价的实验研究[J].中华超声影像学杂志,2013,22(1):74-77.
(10)周永昌,郭万学.超声医学[M].5版.北京:科学技术文献出版社,2006:314-462.
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