多普勒组织成像检测冠心病患者梗死心肌的研究  

Quantitative detection of infarction myocardium in patients with coronary heart disease by Doppler Tissue Imaging

作　　者：沈斌[1] 吾柏铭[1] 余荣水[1] 

机构地区：[1]苏州大学附属第二医院ICU,苏州市215004

出　　处：《岭南心血管病杂志》2004年第5期332-337,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的　测算比较正常室壁心肌和梗死心肌的运动速度 ,评估多普勒组织成像 (DTI)对冠心病梗死心肌的诊断价值。方法　心肌梗死患者 4 6例 ,分成前壁梗死组 2 9例和下壁梗死组 17例 ,健康人 4 8例作对照 ;在心尖左室长轴切面 (alax)上测得室壁节段厚度 ;于心尖四腔心切面(ap4cv)、心尖二腔心切面 (ap2cv)、胸骨旁左室长轴切面(pslax)和alax应用DTI ,按左室壁 16节段 ,测量各室壁节段心肌运动曲线的速度指标 :收缩期峰值运动速度 (Sm) ;舒张早期峰值运动速度 (Em) :收缩期峰值速度梯度 (PVGs) :舒张早期峰值速度梯度 (PVGe) :收缩期跨壁速度梯度 (MVGs) :舒张早期跨壁速度梯度 (MVGe) ,并分别作组间和组内比较。结果　 (1)心梗患者内膜下心肌绝大多数节段性的室壁运动速度降低 ,与对照组存在显著差异 (P <0 0 1或 <0 0 5 ) :(2 )前壁梗死患者前间隔峰值速度梯度 (PVG)与跨壁速度梯度、(MVG)降低 ,中间段明显降低 (P <0 0 1或 <0 0 5 ) ,后壁基底段的MVGs 显著升高 (P <0 0 5 ) ;前间隔PVG、MVG明显小于后壁 (P <0 0或 <0 0 5 ) ;(3)下壁梗死患者各室壁节段舒张早期峰值速度梯度 (PVGe)除后壁基底段外均降低 ;同水平节段内膜下心肌峰值运动速度 (Sm、Em)趋于一致。Objectives To evaluate the diagnostic value of Doppler tissue imaging(DTI) for detection of infarction myocardium in coronary heart disease. Methods Ventricular wall motions of 46 patients with myocardial infarction(MI)(anterior: 29, inferior: 17) and 48 healthy persons were examined. The thickness of myocardial segments was measured in alax. Having switched to DTI in four views(ap4cv, ap2cv, alax, pslax) and having divided the left ventricular wall into 16 segments, markers (S m, E m, PVG s, PVG e, MVG s, MVG e) of all segments' spectrum curve of ventricular wall motion were measured or calculated by pulsed wave-DTI(PW-DTI) and each of them was compared with in infra-group and in intra-group respectively. Results 1. In each direction, myocardial velocity of endocardium in patients with MI was lower than that of healthy person. The majority of these differences was significant(P<0.01 or <0.05). 2. Patients with MI in anterior wall: The peak velocity gradient(PVG) and myocardial velocity gradient(MVG) of anteroseptum descended and these markers of middle segment were descending significantly (P<0.01 or <0.05). Meanwhile, the base segment's MVG in systolic period (MVG s) of posterior wall ascended significantly (P<0.05). PVG and MVG of anteroseptum were lower than those of posterior wall significantly (P<0.01 or <0.05) 3. Patients with MI in inferior wall: Except for base segment of posterior wall, all walls' PVG in earlier period of diastole(PVG e) descended. All walls' myocardial velocities of endocardium tended to coincidence on the same level of segment.Conclusions Velocity of infarction myocardium is lower significantly than that of normal myocardium in healthy person and it's lower significantly than that of myocardium without MI in patient with MI too. All these differences may be told from by DTI. Myocardium with MI may be recognized by DTI.

关 键 词：多普勒组织成像 检测 冠心病 心肌梗死 诊断 

分 类 号：R541.4[医药卫生—心血管疾病] R542.22[医药卫生—内科学]