二维超声结合脉冲组织多普勒成像对急性心肌梗死患者收缩功能的评价  

Evaluation of left ventricular systolic function after acute myocardial infarction by two-dimension echocardiography and pulse wave-Doppler tissue imaging

作　　者：沈晓棠[1] 周长钰[2] 蔡金荣[2] 郑成环[2] 叶岚[2] 王伟[2] 

机构地区：[1]内蒙古赤峰市医院,内蒙古赤峰024000 [2]天津医科大学第二医院,天津300211

出　　处：《中国心血管杂志》2007年第5期352-356,共5页Chinese Journal of Cardiovascular Medicine

基　　金：天津市高等学校科技发展基金项目(编号:20020225)

摘　　要：目的通过心电图(ECG)QRS波记分对急性心肌梗死(AMI)后坏死面积大小进行分组,测量二维超声及脉冲组织多普勒成像(PW-DTI)心脏收缩指标,以评价不同治疗方法对不同梗死面积心脏收缩功能的影响。方法根据ECGQRS记分将101例首发AMI患者分为两组。记分≤3分为小面积梗死组(G1组),共43例。记分>3分为大面积梗死组(G2组),共58例。于AMI后1周记录二维超声图象及PW-DTI速度频谱,并在梗死后1个月及3个月进行复测。结果(1)再灌注治疗(溶栓及PCI)3个月时G1组左心室射血分数(LVEF)、S波波峰速度(Vs)、S波速度时间积分(VTIs)及S波加速度(ACCs)均优于G2组,表明梗死面积大则心功能受损明显,虽经再灌注治疗亦不能完全消除梗死面积带来的影响。(2)指标LVEF、Vs、VTIs、ACCs多在梗死3个月时方显现差异,表明心脏功能改善可能发生在梗死1个月以后。(3)在PCI治疗的G2组ΔLVEF、瓣环ΔVs、ΔVTIs均较G1组者改善更明显,而经溶栓治疗的2组间比较差异无统计学意义。表明大面积梗死选择PCI治疗可能获益更大。结论(1)PW-DTI指标能准确反映心脏整体及局部功能的变化,Vs、ACCs可作为判定AMI后心脏功能的指标,ACCs能较Vs更好的表现收缩功能的变化。(2)较大面积的心肌梗死在再灌注治疗中获益更多,大面积心肌梗死选择PCI治疗可能更优于溶栓治疗。Objective To evaluate the left ventricular systolic function in acute myocardial infarction （AMI） patients treated by different reperfusion methods and to compare cardiac function in patients with different infarct size. Methods One hundred and one AMI patients were divided into two groups by QRS scores： Small infarct size group （group G1, n=43） with ECG score 43 and large infarct size group （group G2, n=58） with ECG score〉3. Left ventricular ejection fraction （LVEF）, peak velocity of S wave（Vs） ,velocity time integral（VTIs） ,duration of S wave （Ds） ,acceleration of S wave（ACCs） were measured. The follow up after AMI was 3 months. Results （1） LVEF and Vs, VTIs, ACCs of infarction segment were higher in group G1 than in G2 at 3 months follow up in AMI patients treated with rep＇erfusion therapy. This indicates that cardiac function is worse in larger infarct size patients, and the deterioration of cardiac function can not be completely prevented by reperfusion therapy. （2） The allevation of most parameters occurred at 3 months during follow up （3） ALVEF, annulus AVs and AVTis were higher in G2 group than in G1 group in patients treated with percutaneous coronary intervention, while there was no significant difference of ALVEF, annulus AVs and AVTIs between G1 and G2 groups in patients treated with thromblysis therapy. Conclusions （1） The parameters of PWDTI can accurately reflect the whole and local cardiac function. Vs, ACCs can be used as the parameters to evaluate systolic function. ACCs is better than Vs in assessing systolic function. （2） Larger infarction patients obtained more benefit from reperfusion therapy, and PCI is superior to thromblysis.

关 键 词：急性心肌梗死 溶栓 经皮冠状动脉介入治疗 超声心动图 脉冲组织多普勒成像 

分 类 号：R542.22[医药卫生—心血管疾病] R540.45[医药卫生—内科学]