摘要目的 探讨急性有机磷农药中毒(AOPP)对右室功能的影响.方法 2008年1月至2010年1月随机选取AOPP患者78例,分为轻中度中毒42例和重度中毒36例两组,与我院同期体检的健康对照组32例进行比较,入院后行血胆碱酯酶(CHE)、心电图(ECG)、肌酸激酶同工酶(CK-MB)等检查.应用TDI采集标准心尖四腔心切面右心室游离壁的运动频谱,测量收缩期峰速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),然后用传统脉冲多普勒超声测定三尖瓣口血流速度参数(E、A),计算E/A、Em/Am、E/Em、Tei指数进行对照分析.结果 E/A、Em/Am正常对照组＞轻中度中毒组＞重度中毒组患者,差异有统计学意义(P＜0.001);E/Em、Tei指数正常对照组＜轻中度中毒组＜重度中毒组患者,差异有统计学意义(P＜0.05);而重度AOPP患者右心室Em/Am＜E/A＜1.E/A与Em/Am呈正相关.PAP与右心室E/Em、Tei指数、CK-MB呈正相关,与Sm、Em、右室Em/Am呈负相关(P＜0.001).结论 重度AOPP患者右室收缩和舒张功能均有受损.TDI可准确、定量、无创地评价AOPP患者右心室功能,较传统超声更敏感,更具优越性.

abstractsObjective To evaluate the right ventricular functions of patients with acute organophosphate poisoning patient(AOPP) by measuring the velocities of tricuspid annular motion through Doppler tissue imaging (DTI). Methods Tissue Doppler velocity mode was employed to observe tricuspid annulus movement in 78 AOPP patients and 32 healthy adults. After tricuspid annular pulsed-wave rate of E/A were measured by traditional echocardiographic, the peak values of tricuspid annular early diastolic velocity (Em) and late diastolic velocity ( Am ) were analyzed by DTI. Results E/A ＞ Em/Am ＞ 1 was observed in health control group as well as the mild-moderate AOPP; Em/Am ＜E/A ＜ 1 was observed in the severe AOPP group. There was significant difference between two groups. The right ventricular E/A correlated positively with Em/Am (P ＜0. 001 ). Pulmonary arterial pressure (PAP) correlated positively with right ventricular E/Em, Tei Index ( P ＜ 0. 001 ) and negatively with right ventricular Sm, Em and Em/Am (P ＜ 0. 001 ). Conclusion The right ventricle functions, in terms of contraction and relaxation, decrease in severe AOPP patients versus health control and mild-moderate groups. TDI is a useful tool to assess the right ventricle functions of AOPP patients.