急性心肌梗塞二尖瓣返流的发生机制  

Mechanism of mitral regurgitation in patients with acute myocardial infarction

作　　者：李明洲[1] 张玉梅 沈卫峰[3] 龚兰生[3] 邓开伯[1] 

机构地区：[1]卫生部北京医院心内科,100730 [2]北京崇文区中医院内科,100061 [3]上海第二医科大学附属瑞金医院心脏科,200025

出　　处：《中国急救医学》1999年第11期654-656,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　该文旨在探讨急性心肌梗塞后二尖瓣返流的发生机制。方法　用彩色多普勒超声对９１ 例急性首次心梗入院３ 天内患者按半定量法测定二尖瓣返流。结果　发现伴二尖瓣返流患者左室容积大、球形度大、下壁室壁异常运动积分高。亚组分析发现在前壁梗塞患者中也有类似表现；而在下壁梗塞的患者中，返流组的下壁室壁异常运动积分高，而其它指标差异均无显著意义。Ｌｏｇｉｓｔｉｃ 逐步回归分析发现左室舒张末期球形度和下壁室壁异常运动积分是二尖瓣返流的独立相关因素。结论　左室球形度增大，使乳头肌向两侧移位，以及乳头肌附近的心室壁梗塞或缺血导致的运动障碍是心梗急性期二尖瓣返流的重要机制。Objective To investigate the mechanism of mitral regurgitation(MR)in patients with acute myocardial infarction(MI).Methods Mitral regurgitation,left ventricular(LV) systolic performance,LV sphericity,abnormal wall motion score(AWMS),and diastolic transmitral flow velocity profiles were assessed by color Doppler echocardiography in 91 patients with acute myocardial infarction within 3 days after admision.Results The prevalence of MR was 34%.Patients with MR tended to be higher LV volume indexes(end-diastolic volume index 101±24 ml/m 2 vs 89±20 ml/m 2,end-systolic volume index 65±23 ml/m 2 vs 54±17 ml/m 2,both of P <0 05),increased LV sphericity(end-diastolic 0 638±0 087 vs 0 589±0 104,end-systolic 0 557±0 074 vs 0 519±0 090,both of P <0 05),higher AWMS in inferior wall(4 53±2 72 vs 3 23±2 31, P <0 05),larger left atrial area(21 5±6 3 cm 2,vs 18 8±4 9 cm 2, P <0 05)、greater E/A ratio(1 394±0 963 vs 0 807±0 346, P <0 05).In subgroup analysis,the findings were similar in patients with anterior MI,but in patients with inferior MI,only a higher AWMS in inferior wall was found.In logistic regression analysis,only LV end-diastolic sphericity and AWMS in inferior wall were independently associated with MR.Conclusions It's suggested that lateral migration of papillary muscles caused by increased LV sphericity,and regional wall asynergy near papillary muscles caused by ischamia or infarction are two important mechanisms in patients with MR after acute MI. [

关 键 词：心肌梗塞 二尖瓣返流 左室球形度 发生机制 

分 类 号：R542.220.6[医药卫生—心血管疾病] R542.510.2[医药卫生—内科学]