实时心肌学造影评价急性心肌梗塞介入术后心肌灌注与预后的价值  

Value of real-time myocardial angiography in evaluating myocardial perfusion and prognosis after interventional intervention for acute myocardial infarction

作　　者：陈火梅[1] 赖玉琼[1] 杨希立[1] 莫展[1] 王飞[1] 吴仰帆[1] 冯柳娜 CHEN Huomei;LAI Yuqiong;YANG Xili;MO Zhan;WANG Fei;WU Yangfan;FENG Liuna(Foshan First People's Hospital,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院,广东佛山528000

出　　处：《现代医院》2020年第3期458-462,465,共6页Modern Hospitals

摘　　要：目的应用实时心肌超声造影(MCE)技术评价急性心肌梗塞(AMI)患者不同时间窗行冠脉介入治疗后不同时间段心肌血流灌注对其左心结构和功能改变、临床症状的影响。方法选择2016年6月-2018年6月共300例已行冠脉介入治疗的AMI患者,将其分为急诊PCI组、延迟PCI组,分别于术后早期(术后1周内)、术后6个月、术后12个月行实时心肌声学造影检查,将左室壁分为17节段,运用Q-analysis软件进行心肌灌注的定量分析。根据心肌灌注造影结果进行室壁运动评分及MCE半定量评分,应用二维应变软件测量各个节段的收缩期纵向峰值应变,测量并比较左室舒张末期内径(LVDd)、左室射血分数(LVEF)及记录临床症状。结果所有患者均顺利完成MCE,无不良反应发生,其中1365个节段心肌因透声条件及侧方声影的影响被排除。血运重建术前,MCE评价存活心肌为969节段,无存活心肌为227节段,敏感性、特异性及准确性分别为88.39%、68.7%和87.8%。血运重建术前,二维超声心动图发现共有1364个室壁明显发生节段性运动异常,其中有1049个室壁的节段性运动异常术后得到改善。心肌灌注改善组(1049个节段)术前心肌收缩期纵向峰值应变明显高于心肌灌注无改善组(315个节段)[(-7.34±5.84)%vs(-2.11±1.66)%,P<0.001]。以术前心肌收缩期纵向峰值应变≤-5.0%作为截断值判断心肌梗死时存活心肌的敏感性为72%,特异性为85%。急诊PCI组和延迟PCI组两组患者在性别、年龄、合并心血管疾病和吸烟史等基线比较均无统计学差异(P>0.05)。急诊PCI组住院时间明显较延迟PCI组缩短(P<0.05);急诊PCI组LVDd明显小于延迟PCI组(P<0.01),而LVEF明显高于延迟PCI组(P<0.01)。结论MCE可以有效准确地预测梗死心肌的存活性,以MCE为评价心肌灌注的方法,可以检测AMI患者PCI后的心肌灌注水平,并分析心肌灌注水平及左室重构的关系。根据MCE的结果分析:急诊PCI�Objective Real-time myocardial contrast imaging(MCE)was used to evaluate the effects of myocardial blood flow perfusion on the structure and function of left heart and clinical symptoms in patients with acute myocardial infarction(AMI)with different time windows after coronary intervention.Methods From June 2016 to June 2018,300 patients with AMI who had undergone coronary intervention were divided into emergency PCI group and delayed PCI group,respectively,at the early stage of operation(within 1 week after operation)and 6 months after operation.Twelve months after operation,the left ventricular wall was divided into 18 segments by real-time contrast echocardiography.The quantitative analysis of myocardial perfusion was performed by Q-analysis software.The left ventricular wall motion score and MCE semi-quantitative score were performed according to the results of myocardial perfusion angiography.The longitudinal peak systolic strain of each segment was measured by two-dimensional strain software,and the left ventricular end-diastolic diameter(LVDd)was measured and compared.Left ventricular ejection fraction(LVEF)and clinical symptoms were recorded.Results All patients successfully completed MCE without adverse reactions,of which 1365 segments of myocardium were excluded due to the effects of sound transmission and lateral acoustic shadow.Prior to revascularization,MCE evaluated 969 segments of viable myocardium and 227 segments of non-viable myocardium.The sensitivity,specificity,and accuracy were88.39%,68.7%,and 87.8%,respectively.Before revascularization,two-dimensional echocardiography revealed that a total of 1364 ventricular wall segments had abnormal segmental motion abnormalities,of which 1049 ventricular segmental motion abnormalities were improved after surgery.The peak longitudinal strain of myocardial systole during preoperative myocardial systole was significantly higher in the myocardial perfusion group(1049 segments)than in the non-improved myocardial perfusion group(315 segments)[(-7.34±5.84)%vs

关 键 词：心肌学造影 急性心肌梗塞 经皮冠脉介入术 心脏灌注 左室舒张末期内径 左室射血分数 

分 类 号：R445.1[医药卫生—影像医学与核医学]