經(jīng)食管RT—3DTEE評(píng)估房顫患者左心耳形態(tài)、結(jié)構(gòu)與血栓形成及其關(guān)系分析

　　【摘要】 目的：探討經(jīng)食管實(shí)時(shí)三維超聲心動(dòng)圖（RT-3DTEE）在評(píng)估房顫患者左心耳形態(tài)、結(jié)構(gòu)及其與血栓形成關(guān)系中的應(yīng)用價(jià)值。方法：選擇應(yīng)用經(jīng)食管RT-3DTEE檢查的47例房顫患者及52例非房顫患者作為研究對(duì)象，評(píng)價(jià)并比較兩組患者的左心耳開口面積（LAA-O）、左心耳容積（LAA-V）、左心房容積（LA-V）、左心耳長(zhǎng)徑（LAA-L）、左心耳射血分?jǐn)?shù)（LAA-EF）、左心耳血流速度（LAA-v）等指標(biāo)。將房顫組進(jìn)一步分為A組（無自發(fā)顯影組）、B組（自發(fā)顯影組）和C組（血栓組），比較各組上述指標(biāo)變化情況。結(jié)果：與非房顫組相比，房顫組患者LAA-O、LAA-L、LA-V、LAA-V均較高，而LAA-v及LAA-EF均較低，比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。房顫組中不同亞組間指標(biāo)LAA-EF和LAA-L比較，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；C組的LAA-V、LAA-O及LA-V均明顯大于A組（P<0.05），C組和B組的LAA-v則明顯小于A組（P<0.05）。Pearson相關(guān)性分析結(jié)果顯示，房顫組患者左心耳開口寬度、左心耳開口面積和左心耳最大容積呈明顯正相關(guān)（r=0.748、0.641，P<0.01），左心耳最大容積與左心耳射血分?jǐn)?shù)及排空血流速度呈明顯負(fù)相關(guān)（r=-0.254、-0.521，P<0.05）。結(jié)論：房顫患者左心耳形態(tài)和結(jié)構(gòu)的改變與血栓形成密切相關(guān)，而采用經(jīng)食管RT-3DTEE檢測(cè)能夠清楚觀察患者左心耳的結(jié)構(gòu)，從而為臨床診斷和治療提供更多可靠的參考依據(jù)。
　　【關(guān)鍵詞】 心房顫動(dòng)； 左心耳； 三維； 超聲心動(dòng)圖； 血栓形成
　　Application Value of RT-3DTEE in the Assessment of Atrial Fibrillation Patients with Left Atrial Appendage Morphology，Structure and Its Relation with Thrombosis/LI Xingwen，WU Liping.//Medical Innovation of China，2018，15（07）：031-034
　　【Abstract】 Objective：To investigate the application value of RT-3DTEE in the assessment of atrial fibrillation patients with left atrial appendage morphology，structure and its relation with thrombosis.Method：47 cases with atrial fibrillation which received RT-3DTEE examination were selected as AF group，52 cases with non atrial fibrillation which received RT-3DTEE examination were selected as the non AF group.LAA-O，LAA-V，LA-VLAA-L，LAA-EF，LAA-v and other indicators were compared between two groups.The AF group were further divided into the A group（none spontaneous echo contrast），B group（spontaneous echo contrast） and the C group （the thrombus group），the above indices were compared among the three groups.Result：LAA-O，LAA-L LA-V，LAA-V of the AF group were higher than those of the non AF group，while LAA-v and LAA-EF of the AF group were lower than those of the non AF group，the differences were statistically significant（P<0.05）.The levels of LAA-EF and LAA-L in AF 3 groups were significantly different（P<0.05）.LAA-V，LAA-O and LA-V of C group were significantly higher than those of A group（P<0.05），LAA-v of C group and B group were less than that of A group（P<0.05）.There was a significant positive correlation between the left atrial appendage width， the left atrial appendage area and the maximum volume of left atrial appendage in the patients with atrial fibrillation（r=0.748， 0.641； P<0.01）， the maximum volume of left atrial appendage was negatively correlated with left auricle ejection fraction and emptying velocity （r=-0.254， -0.521； P<0.05）.Conclusion：AF patients with left atrial appendage morphology and structure changesare closely related to thrombogenesis.The structure of the left atrial appendage in patients can be clearly observed by using RT-3DTEE.Using RT-3DTEE can provide more reliable basis for the clinical diagnosis and treatment.

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