【摘要】 目的探讨QRS波时限、常规超声心动图及组织多普勒成像技术在评价不同室内传导阻滞患者心室同步化中的应用价值。方法根据QRS波时限(≥120 ms),将60例室内传导阻滞患者分为完全性右束支传导阻滞(CRBBB)、完全性左束支传导阻滞(CLBBB)及不定型室内传导阻滞(AICD)3组,每组20例;另选QRS波时限(<120ms)的健康人群20例为对照组。比较4组心功能、心脏同步化相关指标。结果CRBBB、CLBBB、AICD 3组相关指标显著高于对照组,其中位数和四分位数间距分别为纽约心功能(NYHA)分级1.00(1.00)、2.00(1.00)、1.00(1.00)vs 0.00(0.00),左心室收缩末期容积41.50(31.00)ml、92.00(51.25)ml、54.50(39.25)ml vs 41.85(37.50)ml,左心室舒张末期容积106.50(85.50)ml、150.50(117.25)ml、118.00(97.25)ml vs 109.00(98.00)ml,左心室射血分数59.50(56.25)%、43.50(37.25)%、50.00(42.50)%vs 61.00(59.25)%,左右心室射血前时间差值23.00(15.00)ms、47.00(28.75)ms、33.50(15.00)ms vs 15.00(14.00)ms,室间隔与左心室后壁收缩延迟时间42.50(17.75)ms、175.00(88.75)ms、65.00(40.00)ms vs 45.00(35.50)ms,左心室侧壁与室间隔基底段达峰时间差30.00(20.00)ms、70.00(20.50)ms、30.00(18.50)ms vs 20.00(10.00)ms,左、右心室侧壁基底段达峰时间差40.00(22.50)ms、80.00(42.50)ms、35.00(20.00)ms vs 20.00(10.00)ms,QRS波时限160.00(120.00)ms、150.00(128.00)ms、123.00(120.00)ms vs 82.00(80.00)ms及N端-B型利钠肽前体(NT-proBNP)135.50(60.00)ng/L、1098.00(516.25)ng/L、710.00(300.00)ng/Lvs 247.00(93.00)ng/L(P<0.05)。其中,CLBBB组与对照组比较差异显著,AICD次之;CRBBB组与AICD组比较差异无统计学意义。结论QRS波时限与心室同步化有明显的相关性,常规超声心动图及组织多普勒成像新技术在评价和筛选心室同步化指标中具有明显的价值。QRS波时限、NT-proBNP与心室收缩功能不全均具有相关性。更多还原

【Abstract】 Objective To investigate the QRS wave duration,conventional echocardiography and tissue Doppler imaging in the evaluation of new technologies in different ventricular synchrony in patients with intraventricular conduction delay in the application of the value of QRS wave duration,N terminal-B-type natriuretic peptide ventricular systolic dysfunction and correlation.Methods Sixty patients with intraventricular conduction delay were enrolled in this study.According to the QRS wave duration(≥120 ms),the patients were divided into complete right bundle branch block(CRBBB),complete left bundle branch block(CLBBB) and atypical intraventricular conduction delay(AICK),each group included 20 patients;other choice included QRS wave duration(<120 ms) of 20 cases from healthy people as a control group.Upon completion of the clinical data collection,cardiac functions and tissue Doppler synchronization parameters were compared among four groups.Results CRBBB,CLBBB,AICD related in three groups were significantly higher than those of control group,with a median and quartile of cardiac function were 1.00(1.00),2.00(1.00),1.00(1.00) vs 0.00(0.00),LVESV 41.50(31.00) ml,92.00(51.25) ml,54.50(39.25) ml vs 41.85(37.50) ml,LVEDV 106.50(85.50) ml,150.50(117.25) ml,118.00(97.25) ml vs 109.00(98.00) ml,LVEF 59.50(56.25)%,43.50(37.25)%,50.00(42.50)% vs 61.00(59.25)%,LRVPEI 23.00(15.00) ms,47.00(28.75) ms,33.50(15.00) ms vs 15.00(14.00) ms,SPWMD 42.50(17.75) ms,175.00(88.75) ms,65.00(40.00) ms vs 45.00(35.50) ms,Ts 130.00(20.00) ms,70.00(20.50) ms,30.00(18.50) ms vs 20.00(10.00) ms,Ts 240.00(22.50) ms,80.00(42.50) ms,35.00(20.00) ms vs 20.00(10.00) ms,QRS wave duration was 160.00(120.00) ms,150.00(128.00) ms,123.00(120.00) ms vs 82.00(80.00) ms,and NT-proBNP 135.50(60.00) ng/L,1098.00(516.25) ng/L,710.00(300.00) ng/L vs 247.00(93.00) ng/L(P<0.05).Among which,CLBBB group compared with control group,difference was significant,AICD followed;CRBBB group had no significant difference with AICD group.Conclusion QRS wave duration had significant correlation with ventricular synchronization conventional echocardiography and tissue Doppler imaging has significant value in the evaluation of new technologies and screening index of ventricular synchronization.QRS wave duration,NT-proBNP and left ventricular systolic dysfunction were not relevant.更多还原