用彩色多普勒超声心动图探讨心肌梗塞时二尖瓣返流与乳头肌功能不全的关系  

The Relationship between Mitral Regurgitation and Papillary Muscle Dysfunction and Myocardial Infarction

作　　者：王丽娣[1] 吴轶凡[1] 吕增城[1] 张玉兰[1] 

机构地区：[1]天津市胸科医院,300052

出　　处：《天津医药》1997年第2期71-73,共3页Tianjin Medical Journal

摘　　要：对心肌梗塞后4周～半年的83例患者,用二维超声心动图及实时彩色血流成像技术,探查到二尖瓣有病理性返流者70例,乳头肌功能不全22例。探讨心肌梗塞时乳头肌功能不全与梗塞位置、返流严重程度之间的关系。结果,前壁梗塞组46人,有返流35人(76.1％);下壁梗塞组22人,有返流20人(90.9％),二者无显著差异(P>0.05);比前壁+下壁梗塞组(15/15例,100％)为低(P<0.05)。乳头肌功能不全在下壁组9人(40.9％),前壁+下壁组7人(46.7％)均比前壁组6人(13.0％)为高(P<0.01)。室壁异常运动范围与返流束面积相关好,前壁组Y=13.2X—0.3,r=0.54,P<0.01;下壁组Y=41.3X—4.7,r=0.55,P<0.01。下壁组室壁异常运动范围0.23±1低于前壁梗塞组0.30±0.1(P<0.01);然而,下壁组返流面积5.61±4.5却大于前壁组3.70±3.4,(P<0.05),且下壁组返流方向以后向为主(80.0％),前壁组中向为主(54.3％)。结论:在心肌梗塞时,乳头功能不全是二尖瓣返流的重要原因,且二者并存时返流程度要严重,下壁梗塞组的发生率明显大于前壁组。Eighty-three cases of myocardial infarction (MI) in 1-6 months after the attack were examined by two-dimensional echocardiography and real-time two-dimensional Doppler flow imaging. Seventy cases had pathological mitral regurgitation (MR) and 22 cases had papillary muscle dysfunction (PMD). The purpose of the study was to establish the relationship between PMD and infarction location and severity of regurgitation. The results showed that anterior MI 35/46 cases had MR (76. l%),and inferior MI 20/22 cases had MR(90. 9%). There was no significant difference(P> 0. 05). The extent of wall-motion abnormality correlated significantly with the area of MR jet in the inferior MI group(Y = 41. 3X - 4. 7, r=0. 55,P<0. 01)and in the anterior MI group(Y,= 13. 2X -0. 3, ,r = 0. 54,P<0. 01). However in the inferior MI group the extent of wall-motion abnormality (0. 23 ± 0. 1) was lower than anterior MI group(0. 30 ± 0. 1,P<0. 01),and the area of MR jet was (5. 61 ± 4. 5) larger than the anterior MI group(3. 70±3. 4, P<0. 05>. But the direction of MR in the inferior MI group was mostly in the backward direction(80% ) ,and in the anterior MI group it was mostly in the middle direction(54. 3%). In the MI,PMD was the main cause of the MR. The severity of MR and percentage in the inferior MI group were significantly higher than anterior MI group.

关 键 词：心肌梗塞 乳头肌功能不全 二尖瓣返流 

分 类 号：R542.220.2[医药卫生—心血管疾病]