实时心肌声学造影结合腺苷负荷试验对冠心病介入治疗前后心肌灌注的评价  

Assessment of myocardial perfusion before and after intervention therapy of coronary heart dis- ease by real-time myocardial contrast echocardiography combined with adenosine stress echocar- diography

作　　者：吴向军[1] 王庆元[1] 马风妹[1] 

机构地区：[1]山东省滨州市人民医院心内科,256600

出　　处：《中国实用医刊》2013年第1期9-12,共4页Chinese Journal of Practical Medicine

摘　　要：目的评价冠心病（CHD）经皮冠状动脉介入治疗（PCI）术前后心肌灌注情况。方法选择经冠状动脉造影（CAG）证实有冠状动脉狭窄的冠心病患者共42例，对入选的冠状动脉狭窄的患者在行PCI术前后进行经静脉心肌声学造影（MCE）结合腺苷负荷检查，通过心肌显影程度定量判断冠状动脉微循环灌注并记录图像，将治疗前后心肌声学造影结果进行对比分析，评价手术疗效，估计患者预后。结果23例患者经PCI术治疗后，相关心肌节段的局部所有毛细血管横截面积之和（A）、血流速度（p）、心肌的血流量（A×B）均较冠状动脉介入前显著增加（P〈0．05）；PCI术后相关心肌节段组与冠状动脉正常者心肌节段组比较，局部所有毛细血管横截面积之和、血流速度、心肌的血流量A、B、AXp仍减低（P〈0．05）；相关分析显示，随访期EF值和室壁运动记分指数较术前明显增加，并与PCI术治疗后A、B、A×母相关性好（P〈0．01）。结论经静脉心肌声学造影结合腺苷负荷检查为冠心病诊断治疗领域提供一种准确、无创评价心肌微循环的临床检测手段；进一步评价经皮冠状动脉介入治疗对改善心肌梗死患者心肌组织灌注的效果。未经再灌注治疗的心肌梗死或心绞痛患者应尽早行择期PCI术，挽救梗死区的缺血心肌，改善左心室功能。Objective To evaluate the situation of myocardial perfusion before and after percuta- neous coronary intervention （PCI）. Methods Forty-two patients with coronary artery stenosis confirmed by coronary angiography were selected. Transvenous myocardial contrast echocardiography and adenosine stress echocardiography were administered for the patients. Coronary microcirculation perfusion was quan- titatively judged through the extent of myocardial visualization and the images were recorded, the results of myocardial contrast eehocardiography were compared, the surgical efficacy was evaluated, and the prognosis was estimated. Results In 23 cases, after PCI, the correlation-myocardial segments to the partial cross sectional area of all the capillaries （ A）, blood flow velocity （ 13 ）, myocardial blood flow volume（ A x 13） all increaser significantly than before the percutaneous coronary intervention （ P 〈 0.05 ） ; PCI postoperative the correlation-myocardial segments group compared to the coronary artery nor- mal subjects of the correlation-myocardial segments group, the partial cross sectional area of all the capil- laries, blood flow velocity, myocardial blood flow volume still all decreased （ P 〈 0. 05 ） , correlation a- nalysis showed, follow-up period EF values and wall motion score index increased significantly compared with the preoperative, and after treatment with PCI in A, 13, A x 13 good correlation （P 〈 0. 01 ）. Con- clusions Transvenous myocardial contrast echocardiography combined with adenosine stress provide an accurate, noninvasive evaluationof myocardial microcirculation for the diagnosis and treatment of coronary heart diseaset; further evaluate the treatment of percutaneous coronary intervention in patients with myo- cardial infarction to improve myocardial perfusion in effect. Patients with angina pectoris or myocardial in- farction without reperfusion therapy should be treated with delayed PCI as early as possible, in order tosave the ischemic myocardial infarction

关 键 词：经静脉心肌声学造影 腺苷 冠心病 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]