经食管RT—3DTEE评估房颤患者左心耳形态、结构与血栓形成及其关系分析

　　【摘要】 目的：探討经食管实时三维超声心动图（RT-3DTEE）在评估房颤患者左心耳形态、结构及其与血栓形成关系中的应用价值。方法：选择应用经食管RT-3DTEE检查的47例房颤患者及52例非房颤患者作为研究对象，评价并比较两组患者的左心耳开口面积（LAA-O）、左心耳容积（LAA-V）、左心房容积（LA-V）、左心耳长径（LAA-L）、左心耳射血分数（LAA-EF）、左心耳血流速度（LAA-v）等指标。将房颤组进一步分为A组（无自发显影组）、B组（自发显影组）和C组（血栓组），比较各组上述指标变化情况。结果：与非房颤组相比，房颤组患者LAA-O、LAA-L、LA-V、LAA-V均较高，而LAA-v及LAA-EF均较低，比较差异均有统计学意义（P<0.05）。房颤组中不同亚组间指标LAA-EF和LAA-L比较，差异均有统计学意义（P<0.05）；C组的LAA-V、LAA-O及LA-V均明显大于A组（P<0.05），C组和B组的LAA-v则明显小于A组（P<0.05）。Pearson相关性分析结果显示，房颤组患者左心耳开口宽度、左心耳开口面积和左心耳最大容积呈明显正相关（r=0.748、0.641，P<0.01），左心耳最大容积与左心耳射血分数及排空血流速度呈明显负相关（r=-0.254、-0.521，P<0.05）。结论：房颤患者左心耳形态和结构的改变与血栓形成密切相关，而采用经食管RT-3DTEE检测能够清楚观察患者左心耳的结构，从而为临床诊断和治疗提供更多可靠的参考依据。
　　【关键词】 心房颤动； 左心耳； 三维； 超声心动图； 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.