无创心肌做功参数评价急性心肌梗死合并心源性休克患者主动脉内球囊反搏治疗早期左心室收缩功能变化  

Non-invasive myocardial work indexes in evaluating left ventricular systolic function in early stage of intra-aortic balloon pump in patients with acute myocardial infarction and cardiogenic shock

作　　者：胡彦斌 崔存英 李亚南 刘园园 王莹 刘琳 HU Yan-bin;CUI Cun-ying;LI Ya-nan;LIU Yuan-yuan;WANG Ying;LIU Lin(Department of Ultrasound,Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University People’s Hospital,Henan Key Laboratory for Cardiovascular Ultrasound Clinical and Basic Research,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院郑州大学人民医院超声科河南省心血管超声临床和基础研究医学重点实验室,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第6期556-559,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82071950);河南省医学科技攻关计划项目(2018020452,LHGJ20190805)。

摘　　要：目的观察急性心肌梗死合并心源性休克患者行主动脉内球囊反搏(intra-aortic balloon pump counterpulsation,IABP)治疗前及治疗早期常规超声心动图参数及无创心肌做功参数变化,探讨无创心肌做功参数评价IABP治疗早期左心室收缩功能的价值。方法急性心肌梗死合并心源性休克患者36例为观察组,均行IABP治疗,同期体检健康者36例为对照组。分别于观察组IABP治疗前、治疗1 h时及对照组体检时行常规超声心动图检查,测量心率、左心房前后径、左心室舒张末期容积、左心室收缩末期容积,分析左心室整体纵向应变,计算心肌做功参数(包括整体做功指数、整体有用功、整体无用功、整体做功效率)。采用Pearson相关法分析观察组患者IABP治疗1 h时整体无用功、整体做功效率与左心室收缩末期容积、左心室舒张末期容积的相关性。结果观察组IABP治疗前心率[(77.3±15.8)次/min]、收缩压[(121.9±14.9)mm Hg]、左心室舒张末期容积[(134.8±32.1)mL]、左心室收缩末期容积[(57.0±11.9)mL]、左心室整体纵向应变[(-12.6±4.2)%]均高于对照组[(62.6±4.9)次/min、(116.2±4.6)mm Hg、(100.9±14.5)mL、(35.6±6.0)mL、(-19.0±2.8)%](P<0.05),舒张压[(58.2±9.4)mm Hg]低于对照组[(71.6±3.3)mm Hg](t=11.312,P=0.001)左心房前后径与对照组比较差异无统计学意义(P>0.05)。观察组IABP治疗前整体做功指数[(1073.3±488.9)mm Hg%]、整体有用功[(1268.4±514.4)mm Hg%]、整体做功效率[(82.3±10.1)%]均低于对照组[(1970.2±153.8)mm Hg%、(2205.0±204.8)mm Hg%、(97.3±0.9)%](P<0.05),整体无用功[(187.5±81.6)mm Hg%]高于对照组[(43.0±16.0)mm Hg%](t=10.418,P<0.001)。观察组IABP治疗1 h时整体无用功[(150.0±78.1)mm Hg%]低于IABP治疗前[(187.5±81.6)mm Hg%](t=-3.051,P=0.004),整体做功效率[(84.2±11.0)%]高于IABP治疗前[(82.3±10.1)%](t=2.410,P=0.021),整体做功指数、整体有用功、左心室整体纵向应变、左心室收缩末期容�Objective To observe the changes of conventional echocardiographic parameters and non-invasive myocardial work indexes in patients with acute myocardial infarction complicated with cardiogenic shock before and in the early stage of intra-aortic balloon pump(IABP),and to investigate the value of non-invasive myocardial work indexes to the evaluation of left ventricular systolic function in the early stage of IABP.Methods Thirty-six patients with acute myocardial infarction complicated with cardiogenic shock were treated with IABP(observation group)and another 36healthy volunteers in the same period were as controls(control group).The heart rate,left atrial anteroposterior diameter,left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were measured by conventional transthoracic echocardiography before and in 1hafter IABP in observation group and during physical examination in control group.The global longitudinal strain(GLS)was analyzed and the global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)were calculated.Pearson correlation was used to analyze the correlations of GWW and GWE with LVEDV and LVESV 1h after IABP in observation group.Results Before IABP,the heart rate[(77.3±15.8)beats/min],systolic blood pressure[(121.9±14.9)mm Hg],LVEDV[(134.8±32.1)mL],LVESV[(57.0±11.9)mL]and GLS[(-12.6±4.2)%]in observation group were higher than those in control group[(62.6±4.9)beats/min,(116.2±4.6)mm Hg,(100.9±14.5)mL,(35.6±6.0)mL,(-19.0±2.8)%](P<0.05),the diastolic blood pressure[(58.2±9.4)mmHg]was lower than that in control group[(71.6±3.3)mm Hg](t=11.312,P=0.001),and there was no significant difference in left atrial anteroposterior diameter between two group(P>0.05).Before IABP,the GWI[(1073.3±488.9)mm Hg%],GCW[(1268.4±514.4)mm Hg%]and GWE[(82.3±10.1)%]in observation group were lower than those in control group[(1970.2±153.8)mm Hg%,(2205.0±204.8)mm Hg%,(97.3±0.9)%](P<0.05),and the GWW[(187.5±81.6)mm Hg%]was highe

关 键 词：急性心肌梗死 心源性休克 无创心肌做功 主动脉内球囊反搏 左心室收缩功能 

分 类 号：R542.22[医药卫生—心血管疾病] R541.78[医药卫生—内科学]