高机械指数三维超声联合微泡改善缺血心肌再灌注  

High mechanical index three-dimensional ultrasound combined with microbubbles in improving myocardial reperfusion

作　　者：高顺记[1] 郭梦娇[2] 刘政[2] 谢峰[3] Thomas R.PORTER 

机构地区：[1]广州军区武汉总医院超声影像科,湖北武汉430070 [2]第三军医大学新桥医院超声科,重庆400037 [3]美国内布拉斯加大学医学中心心内科,美国奥马哈内68198

出　　处：《中国介入影像与治疗学》2014年第9期611-615,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：美国国家卫生总署基金(R01EB009050)

摘　　要：目的探讨经胸三维高机械指数诊断超声联合微泡增强溶栓效果、改善缺血心肌微灌注的可行性。方法将15只冠状动脉左前降支血栓栓塞模型猪分为实验组(n=8)和对照组(n=7)。实验组给予组织型纤溶酶原激活剂(tPA)静脉注射和脂质微泡静脉输注,同时对心前区予高机械指数三维超声辐照30min;对照组仅予tPA静脉注射及微泡静脉输注。观察治疗90min后阻塞冠状动脉再通率、治疗前及治疗90min后缺血区室壁增厚率、危险心肌面积、治疗前及治疗30、60、90min后心电图抬高ST段回落情况。结果治疗90min后,两组冠状动脉再通率差异无统计学意义;实验组室壁增厚率显著高于治疗前,而对照组治疗前后室壁增厚率差异无统计学意义。实验组治疗30、60、90min后,心电图抬高ST段均较治疗前显著回落,而对照组仅在治疗90min后有回落。实验组治疗90min后危险心肌面积较治疗前显著降低,对照组无明显变化;实验组冠状动脉造影无再通者(n=5)治疗90min后造影所示缺血心肌面积较治疗前显著降低。结论冠状动脉造影未显示血管再通时,经胸三维高机械指数超声联合微泡可显著改善猪阻塞区心肌微循环灌注。Objective To observe the feasibility of improving thrombolytic effect and ischemic myocardial microperfusion by transthoracic high mechanical index （MI） three-dimensional ultrasound combining with microbubbles. Methods Fifteen left anterior descending artery occluded pigs were assigned into experimental group （n= 8） and control group （n= 7）. In experimental group, transthorocic high MI three-dimensional ultrasound was applied to precordial chest wall for 30 min with microbubbles infusion after tissue-type plasminogen activator （tPA） administration, while pigs in control group received no transthorocic high MI three-dimensional ultrasound. Recanalization rate of the coronaries 90 min after treatment were compared. Wall thickening of the risk areas, size of risk areas at 90 min after treatment, and ST segment resolution of ECG at 30, 60 and 90 min were compared with baseline in both groups. Results Significant improvement of wall thickening after treatment were achieved in experimental group, though there was no significant difference of epicardial recanalization rates in both groups at 90 min. Significant ST segment resolution of ECG was observed at 30, 60, 90 min after treatment in experimental group, which were absence until 90 min after treatment in control group. There was significant reduction in the size of risk areas 90 min after treatment, even for those without epicardial recanalization in experimental group. Conclusion Combined with microbubbles, transthorocic high MI three-dimensional ultrasound has potential ability to improve myocardial reperfusion of the occluded coronary, even without epicardial recanalization in left anterior descending artery occluded pig models.

关 键 词：超声检查 溶栓治疗 微泡 心肌梗死 

分 类 号：R-332[医药卫生] R445.1