彩色多普勒超声心动图对急性心肌梗死并发室间隔穿孔的临床价值  

Clinical value of color Doppler echocardiography for acute myocardial infarction complicated with ventricular septal perforation

作　　者：丁颖[1] 孙微[1] 刘洁[1] DING Ying SUN Wei LIU Jie.(Department of Ultrasonography, Second Affiliated Hospital of Shenyang Medical College, Shenyang 110002, China)

机构地区：[1]沈阳医学院附属第二医院超声科,110002

出　　处：《中国实用医药》2017年第28期8-10,共3页China Practical Medicine

摘　　要：目的通过对急性心肌梗死并发室间隔穿孔病例的临床特点及彩色多普勒超声心动图(CDE)超声特征的分析和探讨,提高对该病的识别及诊断符合率。方法回顾性分析6例急性心肌梗死并发室间隔穿孔患者应用彩色多普勒超声心动图的全面多次检查结果及诊治结果。结果 6例患者在室间隔穿孔发生12 h内均进行了彩色多普勒超声心动图检查,其中4例患者是在行冠状动脉支架植入术后发生,心动图全部诊断明确。其中4例患者表现为大面积的左室前壁变薄,运动明显减弱,部分近乎消失,其余2例为左室前间壁和下壁的运动减弱;所有病例都有不同程度的左心腔室扩大;3例患者有心尖部变薄伴有矛盾运动,超声心动图判断为室壁瘤形成,收缩功能下降;所有病例都在心尖部附近发现有室间隔的回声失落,宽度约为3.0~10.0 mm,彩色多普勒血流成像(CDFI)显示左向右五彩镶嵌的彩色分流血流信号,其中2例患者为两处缺损,频谱多普勒均可见左向右的高速分流血流信号;其中5例患者有不同程度的二尖瓣和(或)三尖瓣的关闭不全改变。结合临床症状、体征及超声诊断要点,超声心动图均给出明确诊断,其中2例患者经介入封堵术治疗后好转出院,复诊预后良好,2例经外科手术治疗,1例好转,1例术后并发脑出血死亡,另2例经内科治疗处理,后均心力衰竭不治死亡。结论彩色多普勒超声心动图以其对急性心肌梗死并发室间隔穿孔的特异性超声表现,在治疗与预后监测等方面都具有极其重要的临床价值。Objective To analyze and investigate the clinical characteristics and color Doppler echocardiography（CDE） features of acute myocardial infarction complicated with ventricular septal perforation patients, so as to improve the identification of the disease and diagnostic accordance rate. Methods Retrospectively analysis of omprehensive examination results and diagnosis and treatment results of 6 acute myocardial infarction complicated with ventricular septal perforation patients by color Doppler echocardiography. Results Color Doppler echocardiography was performed in 6 patients with ventricular septal perforation within 12 h, including 4 patients occured after coronary stent implantation, and all of the diagnoses were clear by echocardiography. 4 patients showed a large area of the left ventricular anterior wall thinning, significantly weakened movement and some almost disappeared. The remaining 2 cases were decreased left ventricular anterior wall and inferior wall motion. All cases had enlarged left ventricular chambers of varying degrees. 3 patientshad apical thinning complicated with contradictory movement, which was diagnosed as formation of ventricular aneurysm and decreased systolic function by echocardiography. In all cases, there was a loss of interventricular septum near the apex, with a width of 3-10 mm. Color Doppler flow imaging（CDFI） showed left to right colorful inlaid color shunt flow signal, including 2 patients had two defects, and the spectral Doppler showed left to right high speed shunting blood flow signals, and 5 patients had varying degrees of mitral and/or three cusp insufficiency changes. Combined with clinical symptoms, signs and ultrasound diagnosis points, clear diagnosis was made by echocardiography. 2 patients discharged after interventional treatment with good prognosis in revisit, 2 cases underwent surgical treatment, 1 case improved, 1 death case after postoperative cerebral hemorrhage, and the other 2 cases treated by medical treatment and died of heart failure. Conclusio

关 键 词：急性心肌梗死 室间隔穿孔 彩色多普勒超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R542.22[医药卫生—内科学]