实时心肌超声造影对STEMI患者PCI术后继发心肌缺血再灌注损伤的评估价值  

Evaluation value of postoperative myocardial ischemia-reperfusion injury secondary to PCI in STEMI patients by real-time myocardial contrast echocardiography

作　　者：黄泳航[1] 刘少中[1] 郑智文 HUANG Yonghang;LIU Shaozhong;ZHENG Zhiwen(Department of Ultrasound Imaging,Zhongshan City People’s Hospital,Guangdong,Zhongshan 528400,China)

机构地区：[1]广东省中山市人民医院超声影像科,广东中山528400

出　　处：《中国医药科学》2023年第5期159-162,166,共5页China Medicine And Pharmacy

摘　　要：目的 探讨实时心肌超声造影对急性ST段抬高心肌梗死患者早期经皮冠状动脉介入术后继发心肌缺血再灌注损伤(IRI)的评估价值。方法 纳入2019年4月至2021年12月中山市人民医院收治的120例溶栓后行早期经皮冠状动脉介入术后急性ST段抬高心肌梗死患者作为研究对象,根据其术后4 h是否发生IRI进行分组,其中发生IRI者56例(IRI组),未发生IRI者64例(非IRI组),两组患者均完善实时心肌超声造影,采用单因素和多因素分析影响S急性ST段抬高心肌梗死患者早期经皮冠状动脉介入术后继发IRI的风险因素,并采用受试者工作曲线分析评估价值。结果 IRI组年龄高于非IRI组、术后心肌梗死溶栓分级(TIMI)分级低于IRI组,术后冠状动脉狭窄程度高于非IRI组,差异有统计学意义(P <0.05);IRI组超声参数A值、K值及MBF值均较非IRI组偏低(P <0.05)。多因素分析结果显示,术后心肌梗塞溶栓分级及心肌显峰强度值、再充盈平均速度和曲线上升平台期的平均斜率等参数是影响急性ST段抬高心肌梗死患者术后继发IRI的风险因素(P <0.05)。受试者工作曲线结果显示,术后TIMI分级、左心室再充盈平均速度、局部心肌血流量及心肌显峰强度值单一诊断的AUC分别为0.934、0.792、0.759和0.710;敏感度分别为81.23%、80.78%、75.06%和58.32%;特异度分别为72.35%、66.28%、64.81%和73.92%。将特异度最高指标心肌显峰强度值和敏感度最高指标再充盈平均速度进行联合诊断,结果显示,其曲线下面积为0.838,敏感度为77.83%、特异度为79.04%。结论 实时心肌超声造影对急性ST段抬高心肌梗死患者早期经皮冠状动脉介入术后继发IRI的评估价值较高,其敏感度和特异度均较高,值得临床推广。Objective To investigate the evaluation value of postoperative myocardial ischemia-reperfusion injury secondary to early percutaneous coronary intervention(PCI)in acute ST segment elevation myocardial infarction(STEMI)patients by real-time myocardial contrast echocardiography.Methods A total of 120 patients with acute STEMI after early PCI and thrombolysis admitted to and treated in Zhongshan City People’s Hospital from April 2019 to December 2021 were included as the research objects.And they were divided into the group with myocardial ischemia-reperfusion injury(the IRI group,n=56)and the group without myocardial ischemia-reperfusion injury(the non-IRI group,n=64)according to whether they had myocardial ischemia-reperfusion injury 4 hours after operation.Both groups of patients improved real-time myocardial contrast echocardiography.Univariate and multivariate analysis were used to analyze the risk factors of secondary myocardial ischemia-reperfusion injury after early PCI in patients with S acute STEMI,and the receiver operating curve was used to analyze and evaluate the value.Results The ages of the IRI group were older than those of the non-IRI group,the postoperative TIMI grade was lower than that of the non-IRI group,and the postoperative coronary artery stenosis degree was higher than that of the non-IRI group,with statistically significant differences(P<0.05).The ultrasonic parameters A,K and MBF in IRI group were lower than those in non-IRI group(P<0.05).Multivariate analysis results showed that postoperative thrombolytic classification of myocardial infarction,myocardial peak intensity value,average refilling speed and average slope during the plateau period of curve rise,etc.were the risk factors of secondary myocardial ischemia-reperfusion injury in patients with acute STEMI (P < 0.05). The results of the receiver operating curve showed that the AUC of single diagnosis of postoperative thrombolytic classification of myocardial infarction, average refilling speed of left ventricular, regional myocar

关 键 词：实时心肌超声造影 急性ST段抬高心肌梗死 经皮冠状动脉介入术 心肌缺血再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]