实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构  

Evaluation of the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography

作　　者：申屠伟慧[1] 邓又斌[1] 毕小军[1] 张芸[1] 熊莉[1] 余芬[1] 黄润青[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院超声影像科,武汉市430030

出　　处：《临床超声医学杂志》2008年第9期584-587,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构的价值。方法20例准备行血运重建术心肌梗死患者，于术前1～5d行常规超声心动图和实时心肌造影超声心动图检查，并于术后3个月再行常规超声心动图检查。室壁运动分析采用18节段分析法，心肌造影灌注分析：按照心肌灌注记分指数（MPSI）分成2组：MPSI≤1．5为心肌灌注良好组；MPSI〉1．5为心肌灌注较差组。分别将：①两组术前左室射血分数（LVEF）、左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）与术后3个月比较；②两组术前的LVEF、LVESV、LVEDV，术后3个月的LVEF、LVESV、LVEDV各自比较；③两组患者手术前后左室射血分数差值（ALVEF）、收缩末容积差值（ALVESV）、舒张末容积差值（△LVEDV）进行比较；④对ALVEF、△LVESV、△LVEDV与MPSI分别做相关性分析。结果MPSI〉1．5组患者手术后3个月的LVEF较MPSI≤1．5组明显减低，LVEDV较MPSI≤1．5组明显增大，MPSI〉1．5组和MPSI≤1．5组患者的ALVEF、ALVEDV存在差别，差异有统计学意义（P〈0．05）；MPSI与ALVEF呈负相关，与△LVESV、△LVEDV呈正相关（P〈0．05）。结论术前MPSI〉1．5组较MPSI≤1．5组发生左室重构的可能性大，实时心肌超影超声心动图能较好的评估心肌梗死患者血运重建术后左室重构情况。Objective To evaluate the value of left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real - time myocardial contrast echocardiography （RT- MCE）. Methods Intravenous RT- MCE was performed on 20 patients with myocardial infarction before coronary revascularization. Fellow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed by 18 - segment LV model. Myocardial perfusion score index （MPSI） was also calealated. The patients were classified into 2 groups according to the MPSI： MPSI ≤ 1.5 as good myocardial perfusion, MPSI 〉 1.5 as poor myocardial perfusion. The comparison of left ventricular ejection fraction （ LVEF）, left ventricular end - systolic volume （LVESV） and left ventricular end- diastolic volume （LVEDV） between before and 3 months after revascularization in 2 groups was performed; the comparison of LVEF, LVESV, and LVEDV between two groups before and 3 moths after operation were performed; the comparison of △LVEF, △LVESV, and △LVEDV between 2 groups was performed; the linear regression analysis between △LVEF and MPSI, △LVESV and MPSI, △LVEDV and MPSI was also performed. Results The LVEF in patients with MPSI 〉 1.5 was obvious lower than that in patients with MPSI ≤ 1.5 of 3 months after revascularization. The LVEDV in patients with MPSI 〉 1.5 was obvious larger than that in patients with MPSI≤ 1.5 of 3 months later（ P 〈 0.05）. The difference of △LVEF and △LVEDV between patients with MPSI 〉 1.5 and MPSI ≤ 1.5 was significant （ P 〈 0.05 ）. Linear regression analysis showed that MPSI was negative correlated with △LVEF and positive correlated with △LVESV,△LVEDV （ P 〈 0.05 ）. Conclusion RT - MCE can accurately evaluate the value of left ventricular remodeling in patients with myocardial infarction after revascularization.

关 键 词：实时心肌造影 心肌梗死 左室重构 血运重建术 

分 类 号：R540.45[医药卫生—心血管疾病] R473.5[医药卫生—内科学]