二维斑点追踪技术在心肌梗死患者经皮冠状动脉介入术后左室心肌应变评价中的应用  

Applicaction of two-dimensional speckle tracking technology to assessment of left ventricular myocardial strain in patients with myocardial infarction after percutaneous coronary intervention

作　　者：韦舒静[1] 詹正民[1] 郭佳妮[1] 赵献明[2] 

机构地区：[1]广西医科大学附属南宁市第一人民医院超声科,南宁市530022 [2]广西医科大学附属南宁市第一人民医院心血管内科,南宁市530022

出　　处：《广西医学》2016年第6期803-805,共3页Guangxi Medical Journal

基　　金：广西南宁市科学研究与技术开发计划(20123127)

摘　　要：目的应用超声二维斑点追踪技术(2D-STE)评价心肌梗死患者经皮冠状动脉介入(PCI)术后的左室心肌应变情况。方法行PCI术的心肌梗死患者245例,于PCI术前、术后7 d进行64排螺旋CT冠状动脉造影、2D-STE检查。结果245例患者均成功实施PCI治疗,梗死相关血管430支中,PCI术后获成功开通249支(57.9%),开通不良113支(26.3%),开通差63支(14.7%),开通后重新阻塞5支(1.2%)。PCI术后7 d,2D-STE检查提示左室异常节段室壁运动曲线的收缩峰值应变(PSS)、收缩峰值应变率(PSSR)、径向应变(RS)、环向应变(HS)较前明显降低(P<0.05),但119例(48.6%)仍存在节段性室壁运动异常或不良,表现为PSS<10%,PSSR<3%,RS>-7%及HS>-5%。开通后阻塞者牛眼图节段颜色异常,变为淡粉色。结论 PCI术后7 d,心肌梗死患者心肌梗死面积已发生左心室重构,室壁张力增加,心脏收缩功能增强,但近半数的患者仍存在节段性室壁运动异常或不良情况,应加强观察和治疗。2D-STE可以定量观察心肌梗死患者PCI术后的心肌应变情况,客观评价PCI术后心脏收缩功能。Objective To evaluate the left ventrieular myocardial strain of patients with myocardial infarction after percutaneous coronary intervention（PCI） using two-dimensional speckle tracking technique（2D-STE）. Methods A total of 245 patients with myocardial infarction undergoing PCI were enrolled ,and received 64-slice spiral CT coronary angiography and 2D-STE examination before PCI and after 7 days of PCI. Results PCI was successfully conducted in 245 patients. Of 430 branches of the infarct-related artery, patency was observed in 249 （57.9%） after PCI, poor pateney in 113 （ 26.3% ）, bad pateney in 63 （ 14. 7% ）, and re-blocking after patency in 5 （ 1.2% ）. After 7 days of PCI,the result of 2D-STE showed that peak systolic strain（PSS） ,peak systolic strain rate（PSSR） ,radial strain（RS） and hoop strain（HS） of left ventricular segments of abnormal wall motion curve significantly decreased compared to those before operation（ P 〈0.05 ）. But abnormal or poor segmental wall motion still existed in 119 cases（48.6% ） ,and the manifestation included laSS 〈 10% ,PSSR 〈3% ,RS 〉 -7% and HS 〉 -5%. The bull eyes pattern showed that segmental color in the patients with re-blocking after patency was abnormal and turned pink. Conclusion For the patients with myocardial infarction after 7 days of PCI, left ventricular remodeling already exists in the area of myocardial infarction, the tension of ventricular wall increases and cardiac systolic function is strengthened. But abnormal or poor segmental wall motion still occurs in almost half of the patients ,and the intensive observation and therapy is necessary. 2D-STE can be used for quantitatively observing the myocardial contraction in patients with myocardial infarction after PCI,and can objectively evaluate the cardiac systolic function after PCI .

关 键 词：心肌梗死 二维斑点追踪技术 经皮冠状动脉介入术 心肌应变 收缩功能 

分 类 号：R542.22[医药卫生—心血管疾病]