三维斑点追踪成像评价脑利钠肽治疗急性前壁心肌梗死的价值  

Three-dimensional speckle tracking imaging to the evaluation efficacy of rhBNP in patients with acute anterior myocardial infarction

作　　者：张彦[1] 唐媛[1] 高峰[1] 杨肖平[1] 江乃宙 林孙英 陈萍[1] 

机构地区：[1]福建医科大学附属福州市第一医院心血管内科,福建省福州市350009

出　　处：《中国心血管病研究》2015年第6期527-532,共6页Chinese Journal of Cardiovascular Research

基　　金：福建省卫生计生委青年科研课题（项目编号：2014-2-59）

摘　　要：目的 应用超声三维斑点追踪成像（3D-STI）技术评价重组人脑利钠肽（rhBNP）治疗急性前壁或广泛前壁心肌梗死的价值.方法 急性前壁或广泛前壁心肌梗死患者90例被随机分为3组,A组（接受急诊PCI）、B组（急诊PCI＋早期rhBNP治疗）、C组（急诊PCI＋后期rhBNP治疗）.分别在入院6h内,术后1周及术后1、3、6个月对患者进行常规经胸二维超声心动图和实时三维超声心动图检查,应用3D-STI技术测量左心室壁17节段长轴应变、径向应变、圆周应变及面积应变.结果 入院6h内各组EF、LVEDV、LVESV值无明显差异;随着随访时间延长至1周,以及其后的1、3、6、12个月,B组及C组EF大于A组（P＜0.05）,LVEDV、LVESV值小于A组,而B组与C组间未见统计学差异.入院6h内各组前降支对应节段长轴应变无明显差异;随着随访时间延长1、6、12个月,B组长轴应变（术后12个月：BA为17.53±3.10,BAS为15.32±4.87,MA为17.37±3.61,MAS为16.21±3.04,AA为15.61±3.42,AS为16.36±3.56,A为16.32±3.48）及C组（术后12个月：BA为16.77±2.85,BAS为17.36±2.78,MA为16.23±2.63,MAS为14.17±2.93,AA为17.30±3.04,AS为15.23±2.75,A为16.75±4.12）小于A组（术后12个月：BA为8.30±2.59,BAS为7.11 ±2.46,MA为9.37±3.83,MAS为10.67±2.52,AA为7.53±2.27,AS为9.92±2.16,A为10.11±2.59）,而B组与C组间未见统计学差异.径向应变、圆周应变及面积应变均小于A组,而B组与C组间未见统计学差异.结论 rhBNP干预可以改善局部心肌的应变力,从而提高左心室机械功能,改善心肌重构.在入院6h内或术后开始应用rhBNP,在改善心脏功能、抑制心肌重构方面无明显差异.Objective To evaluate the effect of rhBNP in patients with acute anterior myocardial infarc- tion by 3-dimensional speckle tracking imaging. Methods Ninety cases suffered acute anterior wall or extensive anterior wall myocardial infarction patients, were randomly divided into 3 groups： Group A （n=29）： Emergency PCI group; Group B （n=29）： Emergency PCI±eariy rhBNP treatment group and Group C （n=32）： Emergency PCI±late rhBNP treatment group. Conventional two-dimensional echocardiography and real-time three-dimensional echocardiography were detected in 6 hours of hospitalization, after operation 1 week, after operation 1, 3, 6 months. Longitudinal strain （LS）, circumferential strain （CS）, radial strain （RS） and area strain （AS） in 17 LV segments were acquired by 3D-STI respectively. Results No obvious difference was found between EF, LVEDV, LVESV of each group within 6 hours after admission. Within 6 hours after admission, the long-axis variables corresponding to anterior descending artery segments in each group showed no significant differences. With prolonged follow-up at 1 month, 6 months, and 12 months, the long-axis variables in Groups B （BA 17.53±3.10, BAS 15.32±4.87, MA 17.37-±3.61, MAS 16.21±3.04, AA 15.61±3.42, AS 6.36±3.56, A 16.32±3.48） and C（BA 16.77±2.85, BAS 17.36±2.78, MA 16.23±2.63, MAS 14.17±2.93, AA 17.30±3.04, AS 15.23±2.75, A 16.75± 4.12） were less than those in Group A （BA 8.30±2.59, BAS 7.11±2.46, MA 9.37±3.83, MAS 10.67±2.52, AA 7.53±2.27, AS 9.92±2.16, A 10.11±2.59）, and the difference was statistically significant（P〈0.05）. However, no statistically significant difference was seen between Group B and Group C. The same results were observed in Ra- dial variables, circumference variables area variables. Conclusion This studies have shown that rhBNP therapy can prevent ventricular remodeling after myocardial infarction and improve cardiac function by 3D-STI technique, and there are no statistically significant differenc

关 键 词：心肌梗死 超声心动图 三维斑点追踪成像技术 心室功能 重组人脑利钠肽 

分 类 号：R542.22[医药卫生—心血管疾病]