三维超声评价急性心肌梗死再灌注后左室重构  

The Clinical Evaluation of Left Ventricular Remoldeling after Reperfusion Therapy Using RT3DE in Patients with AMI

作　　者：冯春光[1] 贾三庆[2] 藤一星[2] 宁静[2] 王雷[2] 张宇晨[2] 沈璐华[2] 顾复生[2] 付强[1] 

机构地区：[1]江苏省徐州市中心医院心内科,江苏徐州221009 [2]首都医科大学附属北京友谊医院心内科,北京100054

出　　处：《中国临床医学》2009年第5期778-781,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨实时三维超声心动图对急性心肌梗死患者接受再灌注治疗后左室重构的诊断价值。方法:首次急性心肌梗死接受直接经皮冠状动脉介入治疗(P-PCI)或溶栓治疗患者共53例,比较治疗前及P-PCI治疗后1h、溶栓治疗后2h的心电图上ST抬高段的总和。按ST段下降幅度分为两组:ST段下降≥50%(A组n=32);ST段下降<50%(B组n=21)。于治疗后2d、10d、90d时行M型超声心动图和实时三维超声心动图(RT3DE)检查,分别测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、治疗后90d时LVEDV增大率作为反映左室结构和功能变化的指标,并比较M型超声心动图和RT3DE结果。结果:无论是M型超声心动图还是RT3DE,A组治疗后90d时与治疗后2d相比,LV-EDV、LVESV明显减小,LVEF明显增大(P<0.05);10d时变化不明显(P>0.05)。B组治疗后10d、90d与治疗后2d相比,LVEDV、LVESV均明显增大,LVEF均明显减小。M型超声心动图所测数值均大于RT3DE测值(P<0.05);对于B组,治疗后90d时M型超声心动图所测LVEDV增大率明显大于RT3DE测值(P<0.05)。结论:相比于M型超声心动图,应用RT3DE可更准确地评价急性心肌梗死后左室重构的动态改变;应用M型超声心动图会高估左室重构程度。Objective： To investigate the diagnostic evaluation of RT3DE on the changes of early left ventricular remoldeling after reperfusion therapy in patients with acute myocardial infarction（AMI）. Methods： Consecutive fifty-three patients with first ST elevation AMI treated with reperfusion therapy （primary PCI or thrombolysis） were enrolled. The changes of the ST segment elevation and resolution in electrocardiograms on admission and one hour after PCI or two hours after thrombolysis was analyzed. The patients were divided into two groups according to the extent of ST segment elevation and resolution. Group A （n = 32） ： resolution of ST segment elevation≥50% ; Group B （n = 21 ） ： resolution of ST segments elevation〈50%. Echocardiogram （M mode echocardiography and RT3DE）was checked at 2 d, 10 d,90 d after reperfusion therapy, left ventricular end-diastolic volume （LVEDV） ,left ventricular end systolic volume （LVESV）, left ventricular ejection fraction（LVEF） and augmentation rate of LVEDV at 90 d were measured to reflect the change of left ventricular structure and function,and compare the result of M mode echocardiography and RT3DE. Results： Both M mode echocardiography and RT3DE, in compared with 2 d,it demonstrated that LVEDV and LVESV were significantly decreased, LVEF was significantly increased at 90 d（P〈0. 05）, but that was no significant difference at 10 d （P〉0.05） in Group A. On the other hand, in Group B, it demonstrated that LV- EDV,LVESV were significantly increased,and LVEF was significantly decreased at 90 d and 10 d;the values derived from M mode echoeardiography were higher than that derived from RT3ED（P〈0.05） ; in Group B, the augmentation rate of LVEDV at 90 d derived from M mode echoeardiography was significantly higher than that derived from RT3DE（P〈0. 05）. Conclusions：Compared with M mode echocardiography, RT3DE can evaluate the serial changes of left ventricular remodeling in patients with acute myocardial infarction exactly, a

关 键 词：急性心肌梗死 直接经皮冠状动脉介入治疗 溶栓治疗 实时三维超声心动图 M型超声心动图 左室重构 

分 类 号：R541.4[医药卫生—心血管疾病]