经静脉心肌声学造影的二次谐波显像评价钬激光心肌再血管化治疗实验性心肌缺血  

Evaluation of myocardial perfusion in experimental myocardial ischemia treated by HO:YAG laser using myocardial echocardiographic contrast

作　　者：谢峰[1] 李澎[1] 王立清[1] 勒斌 刘汉英[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院协和医科大学阜外心血管病医院

出　　处：《中华心血管病杂志》1998年第3期220-223,共4页Chinese Journal of Cardiology

基　　金：国家自然科学基金;人事部留学回国人员研究基金

摘　　要：目的利用经静脉心肌声学造影的二次谐波技术非损伤性评价钬激光心肌再血管化（ｔｒａｎｓｍｙｏｃａｒｄｉａｌｌａｓｅｒｒｅｖａｓｃｕｌａｒｉｚａｔｉｏｎ，ＴＭＬＲ）治疗心肌缺血的效果。方法本实验包括１１条杂种犬，体重１５～２８ｋｇ。超声二次谐波显像条件下分别于正常、缺血及心肌激光打孔后经静脉注射声学造影剂ＦＸ４３０（０．０１ｍｌ／ｋｇ）。肉眼观察心肌血流灌注并定量分析心肌声学密度，结果进行统计学处理。结果（１）正常心肌声学造影显像良好，心肌灌注均匀。缺血后显示缺血区明显，缺血部位与结扎的冠状动脉供血范围一致。心肌打孔后造影效果表明，心肌供血改善并可清晰地见到造影剂沿透壁隧道注入心肌。（２）缺血区结扎冠状动脉前后声学密度分别为１１６９±１．６１ｄＢ，５４０±１８１ｄＢ，Ｐ＜０．００１；打孔后为１１０２±２０１ｄＢ，较缺血时显著提高，Ｐ＜０．００１，与正常心肌接近，Ｐ＞０．０５。（３）缺血前待结扎冠状动脉供血区（１１６９±１６１ｄＢ）与对照部位（１３２６±１８２ｄＢ）无显著性差异，Ｐ＞０．０５；缺血后５４０±１８１ｄＢｖｓ１２．６０±１．８２ｄＢ，Ｐ＜０．００１；打孔后１１０２±２０１ｄＢｖ?Objectives To estimate the value of second harmonic imaging by intravenous perfluorocarbon exposed sonicated dextrose albumin (FX430) in immediately assessing the therapeutic effect of experimental myocardial ischemia with HO: YAG laser channels.Methods Eleven open chest dogs (15 28kg) received intravenous injections of FX430 (0.01ml/kg) before and after ligation of the LAD artery and imaged by harmonic transient response imaging. Transmural laser channels were created by HO:YAG laser in the acute ischemic myocardium of LAD area. The regional myocardial perfusion was instantly evaluated after one injection of FX430. Results Visually discernible myocardial echocardiographic contrast was different among the normal, ischemic and laser treated myocardium in the LAD area in all the dogs. The acoustic densitometries (AD) of the LAD areas were 11.69 ±1.61dB and 5.40±1.81dB, respectively before and after ligation of LAD ( P <0.001), and 11.02± 2.01 dB after transmyocardial laser revascularization, while no differences among the other regions in different periods. The contrast agent passed through laser channels was also discerned. Conclusion Myocardial ultrasound contrast produced by intravenous injection of FX430 is an effective method to assess the transmyocardial laser channels in acute myocardial ischemia. Transmural laser channels can improve the regional reperfusion of ischemic myocardium.

关 键 词：心肌缺血 心肌声学造影 二次谐波显像 TMLR 

分 类 号：R542.2[医药卫生—心血管疾病]