利声显心肌声学造影显像在冠脉搭桥术中的应用  

Application of myocardial contrast echocardiography with intravenous injection of Levovist in coronary artery bypass graft

作　　者：吴雪英[1] 舒先红[1] 沈学东[1] 赵强[1] 潘翠珍[1] 李清[1] 周仰仍 沙伟 陈灏珠[1] 

机构地区：[1]上海医科大学附属中山医院暨上海市心血管病研究所,200032 [2]中国安捷伦特公司临床医疗部 [3]德国先灵公司

出　　处：《中华超声影像学杂志》2001年第1期8-11,共4页Chinese Journal of Ultrasonography

基　　金：上海市医学领先专业重点学科资助项目

摘　　要：目的　评价经静脉注射利声显心肌声学造影间隙显像在冠脉搭桥术中的应用价值。方法　用经静脉注射利声显心肌声学造影间隙显像 ,对 2 5例临床诊断为陈旧性心肌梗死准备行冠脉搭桥术患者手术前后的心肌灌注和心脏功能进行分析。结果　术前灌注正常、减弱和无灌注的节段分别为 2 2、5 7和 13个。术后灌注正常、减弱和无灌注的节段分别为 5 5、35和 2个。造影记分指数从术前的 0 .74± 0 .0 8增加到术后的 0 .89±0 .0 6 ,差别有极显著性意义 (P <0 .0 0 1)。 92个与搭桥相关的节段中 ,术后 5 9个 (6 4% )功能改善。室壁运动记分指数从术前的 1.5 0± 0 .2 7减少到术后 1.2 4± 0 .2 0 (P <0 .0 0 1)。左室射血分数从 0 .49± 0 .0 5增加到 0 .5 5± 0 .0 4(P <0 .0 0 1)。手术前后室壁运动记分指数和左室射血分数的变化程度与心肌声学造影检测为存活心肌的节段数高度相关 (r =0 .96 ,0 .82 ,P均 <0 .0 0 1) ;术后室壁运动记分指数和左室射血分数与术前心肌造影记分指数相关 (r =-0 .6 4,0 .6 0 ,P均 <0 .0 5 )。心肌声学造影对冠脉搭桥术后心脏节段功能恢复的预测敏感性和特异性分别为 98%和 36 %。结论　经静脉注射利声显心肌声学造影不仅可用于评价冠脉搭桥术的效果 。Objective To evaluate the value of intermittent myocardial contrast echocardiography (MCE) by intravenous injection of Levovist in coronary artery bypass graft (CABG).Methods The myocardial perfusion and left ventricular function before and after operation in 25 patients with previous myocardial infarction, who were scheduled to undergo CABG, were studied by intermittent MCE after intravenous injection of Levovist.Results The numbers of segment with normal, reduced and no perfusion were 33, 57 and 13 respectively before surgery,and 55, 35 and 2 respectively at follow up. Contrast score index increased from 0.74±0.08 to 0.89 ± 0.06 (P< 0.001 ). In the 92 revascularized segments, 59(64%) were improved. Wall motion score index was 1.50 ± 0.27 at baseline and decreased to 1.24 ± 0.20 after surgery(P< 0.001 ). Left ventricular ejection fraction increased from 0.49 ± 0.05 to 0.55 ± 0.04 at follow up(P< 0.001 ).The Changes of wall motion score index and left ventricular ejection fraction before and after surgery were related significantly to the number of viable dysfunctional segments (r= 0.96 and 0.82 ,P< 0.001 ). Significant correlations were also present between postoperation wall motion score index or ejection fraction and preoperation contrast score index (r= -0.64 and 0.60 ,P< 0.05 ). The sensitivity and specificity of MCE for predicting the recovery of segmental function after CABG were 98% and 36%.Conclusions MCE with intravenous injection of Levovist not only can be used for assessment of CABG, but also predict the recovery of left ventricular function.

关 键 词：超声心动描记术 造影剂 心肌梗塞 冠状动脉分流术 心肌再灌注 

分 类 号：R445.1[医药卫生—影像医学与核医学]