心肌声学造影对急性心肌梗死患者经皮冠状动脉介入术后心肌灌注及预后的评估价值  

Value of myocardial contrast echocardiography in evaluating myocardial perfusion and prognosis in patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：李臻 谷红丽[1] 李锦丽[1] LI Zhen;GU Hongli;LI Jinli(Department of Ultrasound Medicine,the First People’s Hospital of Chenzhou,Hu’nan 423000,China)

机构地区：[1]湖南省郴州市第一人民医院超声医学科,423000

出　　处：《临床超声医学杂志》2023年第3期193-198,共6页Journal of Clinical Ultrasound in Medicine

基　　金：郴州市科学技术局科技发展项目(ZDYF2020127)。

摘　　要：目的探讨心肌声学造影(MCE)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌灌注及预后的评估价值。方法选取急性STEMI并行PCI手术患者78例,根据其术后48 h MCE检查结果分为灌注充盈正常43例(心肌节段造影剂充盈均匀且完全显影,A组)、灌注充盈稀疏20例(心肌节段造影剂充盈不均匀或部分显影,B组),灌注充盈缺损15例(心肌节段造影剂充盈缺损且完全不显影,C组)。应用常规超声心动图和MCE检测各组术后48 h、1个月、3个月左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、二尖瓣环舒张晚期运动速度(Am)、二尖瓣舒张早期峰值流速(E)、二尖瓣舒张早期与晚期峰值流速比值(E/A),比较各组上述参数的差异。记录并比较各组术后6、12、24个月的主要不良心血管事件(MACE)发生率;应用Logistic回归分析急性STEMI患者PCI术后发生MACE的独立危险因素。结果与A组比较,B、C组术后同一时间LVEDV、LVESV、E/A均升高,Am、E、LVEF均降低,差异均有统计学意义(均P<0.05);与B组比较,C组术后同一时间LVEDV、LVESV、E/A均升高,Am、E、LVEF均降低,差异均有统计学意义(均P<0.05)。PCI术后B、C组MACE发生率较A组增高,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,LVEDV、LVESV、LVEF及MCE显示非灌注充盈正常均为急性STEMI患者PCI术后发生MACE的独立危险因素(OR=1.887、2.069、2.291、1.893,均P<0.05)。结论MCE可有效评估急性STEMI患者PCI术后心肌灌注情况,预测术后MACE的发生,有助于患者的预后评估。Objective To explore the value of myocardial contrast echocardiography(MCE)in evaluating myocardial perfusion and prognosis in patients with acute ST-segment elevated myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 78 patients with acute STEMI underwent PCI were enrolled.According to the MCE within 48 h after the surgery,they were divided into 43 cases of normal perfusion filling(contrast agents filling in myocardial segments were even,complete developing,group A),20 cases of sparse perfusion filling(contrast agents filling in myocardial segments were uneven,partial developing,group B)and 15 cases of defected perfusion filling(contrast agents filling in myocardial segments were defected,complete non-developing,group C).The left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),late diastolic mitral valve motion velocity(Am),early peak mitral diastolic flow velocity(E)and ratio of early to late peak diastolic flow rate(E/A)in each group were obtained by routine ultrasound and MCE at 48 h,1 month and 3 months after surgery,and the results were compared and analyzed.The incidence of major adverse cardiovascular events(MACE)at 6,12 and 24 months after surgery was recorded in each group.The independent risk factors of MACE after PCI in acute STEMI patients were analyzed by Logistic regression.Results Compared with group A,LVEDV,LVESV and E/A were increased,while Am,E and LVEF were decreased in groups B and C at the same time after surgery,with statistical significance(all P<0.05).Compared with group B,LVEDV,LVESV and E/A were increased,while Am,E and LVEF were decreased in group C at the same time after surgery,with statistical significance(all P<0.05).The incidence of MACE in groups B and C after PCI was higher than that in group A,and the differences were statistically significant(both P<0.05).The results of Logistic regression analysis showed that LVEDV,LVESV,LVEF and abnormal perfusion filling by

关 键 词：心肌声学造影 超声心动描记术 心肌梗死 ST段抬高型 急性 经皮冠状动脉介入术 心肌灌注 

分 类 号：R540.45[医药卫生—心血管疾病]