目的:探讨三维斑点追踪成像技术(3D-STI)早期评价慢性肾脏病(CKD)患者心肌功能的价值.方法:90例CKD按肾小球滤过率(GFR)分为GFR轻度降低组(Ⅰ组)、中度降低组(Ⅱ组)、重度降低组(Ⅲ组)各30例;40例健康志愿者作为对照组.测量并比较4组的常规超声心动图参数,以及3D-STI应变参数,即左心室整体径向应变(GRS)、整体纵向应变(GLS)、整体圆周应变(GCS)及左心室旋转.结果:与对照组比较,Ⅰ组左心室射血分数(LVEF)降低,左心室质量指数(LVMI)增加,差异均有统计学意义(均P<0.01),其他常规超声心动图参数差异均无统计学意义(均P>0.05).与对照组比较,Ⅱ组和Ⅲ组左心室舒张末期内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及LVMI均增加,LVEF均减低,差异均有统计学意义(均P<0.01或P<0.05).与对照组比较,Ⅲ组左心室收缩末期内径(LVESD)增加,差异有统计学意义(P<0.01).与Ⅰ组比较,Ⅱ组LVPWT、LVMI增加,LVEF降低,差异均有统计学意义(均P<0.01或P<0.05);Ⅲ组LVEDd、LVESD、IVST、LVPWT及LVMI均增加,LVEF降低,差异均有统计学意义(均P<0.01).与Ⅱ组比较,Ⅲ组LVEDd、IVST、LVPWT及LVMI均增加,差异有统计学意义(均P<0.01或P<0.05),LVESD及LVEF差异无统计学意义(P>0.05).与对照组比较,患者组GLS、GRS均降低(均P<0.05),左心室扭转增加(均P<0.05),而GCS差异无统计学意义(P>0.05).与Ⅰ组比较,Ⅱ组GLS、GRS均显著降低(均P<0.01);Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01).与Ⅱ组比较,Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01).结论:CKD患者,病程早期由于圆周方向心肌功能的保持和心肌旋转代偿加强,LVEF可维持正常,但心肌纵向和径向功能降低;3D-STI可早期识别心肌损害,更加敏感地反映左心室收缩功能的改变,为临床决策和疗效评价提供依据.

Objective:To compare the electromechanical synchrony and clinical prognosis between left bundle branch pacing (LBBP) and right ventricular septal pacing (RVSP) , and evaluate the feasibility and safety of LBBP in patients with third degree atrioventricular block.Methods:A total of 100 patients with third degree atrioventricular block requiring permanent pacing treatment from January 2019 to March 2020 in department of cardiology of The Affiliated Hospital of Qingdao University were randomly divided into 2 groups with Random Number Table, and then operating LBBP and RVSP respectively. The left ventricular 12 segment Ts standard deviation (Tsd-12-LV) , pacing parameters, QRS duration (QRSd) , QTc interval, left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter (LVEDD) , left ventricular lateral wall basal segment and right ventricular free wall basal systolic velocity peak time (Ts) (Ts-LV-RV) , and left ventricular filling time and RR interval ratio (LVFT/RR) were followed up and compared between the two groups.Results:Fifty cases of LBBP and 50 cases of RVSP were successfully performed. Pacing threshold, perception and impedance changes were stable after operation, and there was no significant difference between the two groups. six months after procedure, the QRSd[ (110.00±10.96) ms vs. (120.22±22.61) ms], Ts-LV-RV[ (33.88±5.50) ms vs. (38.68±10.33) ms] and LVFT/RR[ (42.38%±3.57%) vs. (54.54%±5.62%) ]in LBBP group were improved, compared with the preoperation ( P<0.05) . The LVEF, LVEDD, Tsd-12-LV and QTc intervals were not significantly different with those before operation ( P>0.05) . The LVEDD, LVEF, Ts-LV-RV and QTc intervals in the RVSP group were not significantly different from those before operation ( P>0.05) , while the LVFT/RR was improved 6 months after operation ( P<0.01) . The QRSd and the Tsd-12-LV of the RVSP group were increased compared with those before operation. No recurrence of heart failure, tachyarrhythmia hospitalization or death and other related events. Conclusion:The pacing parameters of left bundle branch pacing during half-year follow-up were stable. In the aspect of improving electromechanical synchronization, LBBP is better than right ventricular septal pacing.

目的 探讨三维超声心动图(3DE)评价阵发性心房颤动(PAF)患者左心房功能的早期改变.方法 选取PAF患者48例和健康志愿者40例分别为PAF组和对照组,应用3DE及三维斑点追踪成像技术(3D-STI)测定左心房相关结构和功能指标,比较两组间的差异.结果 PAF患者左心房三个时相容积指数均较对照组增大(P＜0.05),功能性指标均减低(P＜0.05).结论 3DE指标可较早识别PAF患者左心房功能的早期改变.