急性心肌梗死局部室壁峰值速度和位移的变化  

Changes of regional peak systolic velocity and displacement of reginal ventricular wall in acute myocardial infarction

作　　者：黄慧贤[1] 胡大一[2] 朱天刚[2] 杨静文[1] 郭实[1] 陈真[1] 丁茜[2] 王欣[2] 权欣[2] 刘俊琪[1] 

机构地区：[1]北京市海淀医院心内科,北京100080 [2]北京大学人民医院,北京100044

出　　处：《中国医学影像技术》2008年第4期541-544,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察组织速度峰值(Sm)和组织位移峰值(D)在急性心肌梗死相关动脉(IRA)供血节段与非梗死相关动脉(NIRA)供血节段急性期的变化,并与正常人相应节段比较,探讨Sm和D能否敏感地评估缺血心肌、坏死心肌。方法以31例首次发病的急性心肌梗死(AMI)患者为研究对象,其中前壁AMI 14例,IRA为前降支(LAD);下壁AMI 17例,IRA为回旋支(LCX)10例,IRA为右冠状动脉(RCA)7例;所有患者均在发病24小时内获取其标准心尖二腔、长轴、四腔彩色组织多普勒,描记心肌各节段的TVI、TT曲线,测量基底段、中段、心尖部收缩相峰值。并与42例正常人对照分析。结果AMI患者的Sm和D与正常人比较结果显示:在前壁和前间隔所有IRA基底段、中段和部分NIRA基底段、中段峰值减低有显著或极显著的统计学差异(P<0.001或P<0.01、P<0.05),峰值减低程度IRA大于NIRA;在侧壁、下壁、后壁和室间隔所有NIRA基底段、中段和部分IRA基底段、中段峰值减低有显著或极显著的统计学差异(P<0.001或P<0.01、P<0.05),峰值减低程度NIRA大于IRA。AMI患者的Sm和D在IRA和NIRA比较提示我们,在前壁AMI组(除外前壁的Sm),前壁和下壁的基底段、中段的Sm和D可以区分梗死与非梗死心肌(P<0.05);在下壁AMI组(除外下壁AMI患者的Sm)侧壁、前间隔、后壁和室间隔中段的Sm和D可以区分梗死与非梗死心肌(P<0.05)。结论AMI患者的Sm和D与正常人比较不仅能够在急性缺血早期无创、定量、准确、敏感地区分正常及缺血、坏死心肌,也能够评估IRA和NIRA的缺血、坏死心肌,为临床提供了可床旁测量、方便快捷的诊疗手段。Objective This study was designed to measure the peak value of velocity （Sm） and displacement （D） of patients with acute myocardial infarction （AMI） during ejection period, and to investigate the capability of Sm and D in separating control from ischemic myocardium or necrosis myocardium, in the meanwhile, to observe the changes of Sm or D in segments of the infarct-related artery （IRA） or non infarct-related artery. Methods The study population included 42 healthy volunteers and 31 patients （14 patients with anterior AMI and 17 patients with inferior AMI） with AMI, in which, IRA was the left anterior descending coronary in 14 patients; IRA was circonflex artery in 10 patients and IRA was right coronary artery in 7 patients. All patients were imaged within 24 hours after they got heart attack. 2D TDI was acquired in all patients, and Sm and D were compared with those in control group. Results In the base and middle of anterior wall or anterior septal in all infarcted regions or in part of non-infarcted regions, Sm and D decreased significantly compared to controls （P〈0. 001 or P〈0.01, P〈0. 05）. In the base and middle of inferior wall, lateral wall, posterior wall and ventricular septum in all non-infarcted regions or in part of infarcted regions, Sm and D decreased significantly compared to controls （P〈0. 001 or P〈0.01, P〈0. 05） ; the capability of Sm and D in separating infarcted regions from non-infarcted regions had been found in all middle segments and base of anterior wall or inferior wall （P〈0.05）. Conclusion Sm and D of patients with AMI appear useful and sensitive for evaluating acute ischemic myocardium or necrosis myocardium. Sm and D is a noninvasive, rapid, accurate and quantitative method that can be measured at bedside to assess AMI.

关 键 词：组织多普勒成像 组织速度 位移 心肌梗塞 冠状动脉造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.22[医药卫生—诊断学]