脉冲组织多普勒成像技术对急性心肌梗死后不同治疗方案的评估  

Assessment of different therapeutic methods by pulsed-wave tissue Doppler imaging after acute myocardial infarction

作　　者：蔡伟[1] 周长钰[2] 刘淑红[1] 蔡金荣[2] 郑成环[2] 

机构地区：[1]武警医学院附属医院心内科,天津300162 [2]天津医科大学第二医院心内科,天津300162

出　　处：《临床荟萃》2005年第9期500-503,共4页Clinical Focus

摘　　要：目的　应用脉冲组织多普勒成像(PWDTI)技术评价急性心肌梗死(AMI)后不同治疗方案对心脏整体及局部室壁功能的改变。方法　AMI患者58例其中经皮冠脉内干预治疗经皮冠状动脉内干预治疗(PCI)组24 例,溶栓组22例,保守治疗组12例;采用PWDTI定量测定患者治疗1周时二尖瓣环及局部室壁运动速度,同时行常规超声心动图检查,并于梗死后1个月及3个月进行随访。结果　二尖瓣环S波峰速度(Vs)、e波峰速度(Ve)、e/a、S波速度时间积分(VTIs)、S波峰加速度(ACCs)等参数PCI组与溶栓组在治疗后1周至1个月和3个月时均比保守组有显著增大(P<0.05),在1个月时PCI组Vs大于溶栓组(P<0.05)。PCI及溶栓组的Vs、VTIs、ACCs在1 周至1 个月及1周至3个月时明显增大,而保守组仅代表收缩功能的VTIs及ACCs也有增大。结论　PWDTI能更准确地定量反映心脏整体功能的变化。Vs、ACCs、及VTIs可作为反映心室收缩功能的主要指标,Ve及e/a可作为反映舒张功能的主要指标,PCI及溶栓治疗优于保守治疗。Objective To evaluate the local and whole function of different therapy in acute myocardial infarction(AMI) by pulsed-wave Doppler tissue imaging (PWDTI) with echocardiography.Methods Fifty-eight AMI patients were divided into percutaneous coronary intervention (PCI) group (twenty-four cases),thrombolysis group (twenty-two cases) and conservative group (twelve cases).The velocities of mitral annulus and infarction segments were measured with PWDTI quantitatively one week after infarction,together with the data of traditional echocardiography.Moreover,all the patients received 1 month and 3 months′ follow-up after infarction,respectively.Results PWDTI parameters of mitral annulus: 1 week,1 month and 3 months after infarction,peak systolic velocity (Vs),peak early diastolic velocity (Ve),e/a,systolic velocity-time integral (VTIs),early diastolic velocity-time integral (VTIe),acceleration of S wave (ACCs) of PCI group and thrombolysis group showed amelioration when compared with those of conservative group′s.Although PCI group had higher Vs at 1 month,there was no significant difference between PCI group and thrombolysis group 3 months after infarction.Self-comparison of each group: Vs,VTIs,ACCs of PCI group and thrombolysis group were improved after therapy.However,only VTIs and ACCs of conservative group,which represent systolic function,were improved.Conclusions PWDTI has better quantitivity and accuracy in reflecting the change of whole heart function of different therapies after AMI.Vs,ACCs and VTIs are the main indexes reflecting systolic function.Ve and e/a are primary parameters in presenting diastolic function.Both PCI and thrombolysis show a better therapteutic effect than conservative therapy.

关 键 词：心肌梗塞 血栓溶解疗法 冠状动脉介入治疗 超声心动描记术 脉冲组织多普勒成像 

分 类 号：R542.22[医药卫生—心血管疾病] R445[医药卫生—内科学]