Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (4): 323-329.doi: 10.24920/003685

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ICU机械通气患者的经胸超声心动图的图像获取研究

王翠1,邓小东2,张宏民1,*(),刘大为1,*(),王小亭1   

  1. 1北京协和医院重症医学科,中国医学科学院 北京协和医学院,北京 100730,中国
    2攀枝花市中心医院重症医学科,四川省,攀枝花市 617067,中国
  • 收稿日期:2019-11-14 接受日期:2020-01-17 出版日期:2020-12-31 发布日期:2020-04-06
  • 通讯作者: 张宏民,刘大为 E-mail:ozohom@163.com;dwliu2015@sina.com

Study on Image Acquisition of Transthoracic Echocardiography in Mechanically Ventilated ICU Patients

Cui Wang1,Xiaodong Deng2,Hongmin Zhang1,*(),Dawei Liu1,*(),Xiaoting Wang1   

  1. 1Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2Department of Critical Care Medicine, Panzhihua Central Hospital, Panzhihua, Sichuan 617067, China
  • Received:2019-11-14 Accepted:2020-01-17 Online:2020-12-31 Published:2020-04-06
  • Contact: Hongmin Zhang,Dawei Liu E-mail:ozohom@163.com;dwliu2015@sina.com

摘要:

目的 探讨重症患者行机械通气后接受经胸超声心动图(transthoracic echocardiography, TTE)成像检查时图像采集过程易于受到不利影响的心脏功能参数。
方法 研究组纳入90例ICU接受机械通气的患者,在同期接受介入治疗的非机械通气患者中,以年龄和体重指数按照1:1与研究组患者进行匹配后作为对照组。对所有纳入研究的患者进行心脏超声检查,通过目测(Eyeballing)法获取右心室(right ventricular, RV)大小、室间隔运动、左室射血分数(left ventricular ejection fraction, LVEF),通过M型超声测量三尖瓣环状平面收缩期偏移(tricuspid annular plane systolic excursion, TAPSE),二尖瓣环状平面收缩期偏移(mitral annular plane systolic excursion,MAPSE),通过脉冲-多普勒超声测量右心室流出道(right ventricular outflow tract,RVOT)的速度-时间积分(velocity-time integral, VTI)和左心室流出道(left ventricular outflow tract,LVOT)VTI,通过心内膜示踪法测量右心室面积变化率(fraction of area change, FAC)及左心室射血分数(left ventricular ejection fraction, LVEF Simpson)。比较在测量以上各参数时,两组之间获得可测量图像的人数差异,以及机械通气ICU患者测量各个参数时获得最佳图像的人数差异。
结果 在研究组中采用M型超声法、脉冲多普勒法和心内膜示踪法获得最佳心脏超声图像的患者明显少于对照组(P<0.05);通过目测法获取RV和LVEF参数时最佳图像获取率在两组之间无显著差异。在研究组中,可取得FAC测量值的患者比率(22.2%)明显少于可获取TAPSE(72.2%,X2=45.139,P<0.001)和可获取RVOT测量值的患者比率(71.1%,X2=43.214,P<0.001)。可获取LVEF Simpson最佳图像的患者比率(37.8%)也明显少于MAPSE(84.4%,X2=41.236,P<0.001)和LVOT VTI(85.6%,X2=43.455,P<0.001)。
结论 在ICU接受机械通气的部分患者中,通过TTE获取最佳心脏超声图像存在一定困难,但采用目测法可较好地评估这类患者的心脏功能。对于定量参数的测量,基于M型超声的心脏纵向运动功能参数评估和基于脉冲多普勒法的VTI参数获取优于心内膜示踪法。

关键词: 危重症, 经胸超声心动图, 医学成像

Abstract:

Objective This study aimed to determine which parameters in transthoracic echocardiography (TTE) are more likely to be affected when applied in a critical care setting with mechanical ventilation.
Methods Ninety mechanically ventilated ICU patients were enrolled into the study group. The control group consisted of 90 patients who underwent interventional therapy. All patients had bedside TTE for parametric measurements including the right ventricular size, septal kinetics and left ventricular ejection fraction (LVEF) by eyeballing (visual assessment), the tricuspid annular plane systolic excursion (TAPSE), mitral annular plane systolic excursion (MAPSE) by M-mode sonography, the right ventricular outflow tract velocity-time integral (RVOT VTI) and left ventricular outflow tract velocity-time integral (LVOT VTI) by pulse-Doppler, the right ventricular fraction of area change (FAC) and left ventricular ejection fraction (LVEF Simpson) by endocardium tracing. We compared the differences in the frequency of optimal image acquisition in assessments of these parameters between the two groups, as well as the differences in acquisition rates of parameter measurements in ventilated ICU patients.
Results There were significantly fewer patients in the study group than in the control group who had optimal images acquisitions for parameter assessments with M-mode method, pulse Doppler method and endocardium-tracing method (P<0.05); no significant difference was obsered in the number of patients with optimal images for RV eyeballing and LVEF eyeballing between the two groups. In the study group, significantly fewer optimal images were acquired for FAC than for TAPSE (22.2% vs. 72.2%, χ2=45.139, P<0.001) and RVOT VTI (22.2% vs. 71.1%, χ2=43.214, P<0.001); there were also fewer optimal images acquired for LVEF Simpson than for MAPSE (37.8% vs. 84.4%, χ2=41.236, P<0.001) and LVOT VTI (37.8% vs. 85.6%, χ2=43.455, P<0.001).
Conclusions Images acquisition of optimal TTE images tend to be difficult in mechanically ventilated ICU patients, but eyeballing method for functional evaluation could be an alternative method. For quantitative parameters measurements, M-mode based longitudinal function evaluation and pulse Doppler-based VTI were superior to the endocardium-tracing based parameter assessments.

Key words: critically ill, transthoracic echocardiography, medical image

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