心肌梗死患者负荷三维超声心动图与冠脉介入治疗结果的对照分析  

Three Dimensional Dobutamine Stress Echocardiography and Follow-up after Revascularization in Myocardial Infraction Patients

作　　者：张宁[1] 徐标[1] 孙步高[1] 杨益宁[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心脏科,南京市210008

出　　处：《中国超声医学杂志》2012年第3期243-246,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的对心肌梗死患者行多巴酚丁胺负荷三维超声心动图试验,与经皮冠状动脉介入治疗后的结果相对照以判断心肌梗死患者的存活心肌。方法研究对象共80例,其中正常组40例,心肌梗死组40例[含左前降支(LAD)病变21例、左回旋支/右冠(LCX/RCA)病变11例、多支病变8例],三维超声心动图检查行左室三维重建,将左心室分为17个节段;心梗患者行经皮冠状动脉介入治疗(PCI),术后复查三维超声,与术前比较整体射血分数(EF)值改善>5%为存活心肌组、EF值改善≤5%为无存活心肌组;心梗组行多巴酚丁胺负荷三维超声检查,比较负荷试验前后左室整体EF及左室壁各节段的EF值。结果 (1)正常组左室壁节段的EF值52%～79%;LAD、LCX/RCA、多支病变相关节段EF值均明显低于正常组相对应节段EF值(P<0.01)。(2)心梗患者于PCI术后3周～1个月复查超声心动图,存活心肌组(33例)左室整体EF值术前、术后为(43±11)%对(47±8)%,改善9%,冠脉病变区相关节段EF值为(34±10)%对(42±15)%(P<0.01);无存活心肌组(7例)EF值术前、术后为(37±9)%对(38±10)%,改善≤5%,冠脉病变区相关节段EF值为(25±10)%对(24±12)%(P>0.05)。(3)心梗组术前行多巴酚丁胺负荷三维超声试验,存活心肌组负荷试验前、后左室整体EF值为(43±11)%对(50±9)%(P<0.05),冠脉病变区相关节段EF值为(34±10)%对(48±16)%(P<0.01);无存活心肌组负荷试验前后左室整体EF值为(37±9)%对(39±7)%(P>0.05),冠脉病变区相关节段EF值为(25±10)%对(27±13)%(P>0.05),负荷三维超声的结果与PCI术后随访结果相吻合。结论心肌梗死后,多巴酚丁胺负荷三维超声心动图的检测结果与PCI术后随访结果相关性良好,利用多巴酚丁胺负荷三维超声心动图检测存活心肌客观、定量化,避免了二维负荷超声心动图试验主观性。Objective The three dimensional dobutamine stress echocardiography was used to assess myocardial viability and to predict the functional recovery after revascularization for myocardial infraction （MI） patients. Methods Forty healthy subjects and forty MI patients were selected. Three dimensional dobutamine stress echocardiography were performed to determine global left ventricular ejection fraction （LVEF） and segmental ejection fraction in MI pa- tients. All MI patients also underwent coronary angiography and percutaneous coronary intervention. Follow-up echo- cardiography was performed 3-4 weeks after revascularization. Global functional recovery and the detection of viable myocardium were identified if LVEF had improved by 〉5% on 3D echocardiography. Results The segmental EF was 52%-79% in normal subjects. For MI patients there were lower segmental EF within the infract zone and the seg- mental EF of most sections where coronary artery had positive stenosis were significantly lower than those of corre- sponding sections in normal subjects. After revascularization there were 33 patients （the group of viable myocardium） showed global functional and segmental recovery, the global EF baseline versus follow-up, （43± 11）% versus （47± 8） % and the segmental EF of the infract zone baseline versus follow-up, （34±10）% versus （42±15）% and 7 patients without viable myocardium, the global EF baseline versus follow-up, （37 ±9）% versus （38 ±10） % and the seg- mental EF baseline versus follow-up, （25± 10）% versus （24±12）%. The three dimensional dobutamine stress echo- cardiography （DhE） were performed for MI patients. Of 40 MI patients, the group of viable myocardium had improve- ment of global EF,EF baseline versus stress, （43± 11）% versus （50±9）% and segmental EF within the infract zone,EF baseline versus stress, （ 34 ± 10 ）% versus （48 ± 16 ）%, but the group without viable myoeardium did not, the glob- al EF（37±9）% versus （39±7）% and th

关 键 词：实时三维超声心动图 负荷超声心动图 经皮冠状动脉介入治疗 存活心肌 左室射血分数 

分 类 号：R542.22[医药卫生—心血管疾病] R540.45[医药卫生—内科学]