超声心动图对重症心肌炎诊断价值  

Value of echocardiography in diagnosis of severe myocarditis

作　　者：田书铭 金岩 赵洋 刘宇 都业君 TIAN Shu-ming;JIN Yan;ZHAO Yang;LIU Yu;DU Ye-jun(Postgraduate Training Base of General Hospital of Northern Theater Command of Jinzhou Medical University,Shenyang 110016,China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,辽宁沈阳110016 [2]北部战区总医院心血管外科,辽宁沈阳110016

出　　处：《临床军医杂志》2024年第2期116-120,共5页Clinical Journal of Medical Officers

基　　金：国家自然科学基金(82070239)。

摘　　要：目的探讨超声心动图在成人重症心肌炎(SM)诊疗中的应用价值,为临床及时有效地诊断及应用体外膜肺氧合(ECMO)辅助治疗提供重要参考。方法选取自2018年9月至2021年12月于北部战区总医院住院治疗的29例SM患者设为重症组,再根据是否采用ECMO治疗将其分为ECMO组(n=9)和非ECMO组(n=20);另选取同期同年龄段的30例体检结果正常的体检者作为健康组。比较重症组和健康组,以及ECMO组和非ECMO组的超声参数[左心房内径(LAD)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、室间隔(IVS)、左室后壁厚度(LVPW)、室壁增厚率、左室射血分数(LVEF)、二尖瓣舒张早期峰速(Em)、三尖瓣舒张早期峰速(Et)、二尖瓣舒张晚期峰速(Am)、三尖瓣舒张晚期峰速(At)、二尖瓣瓣环侧壁处舒张早期峰速(Em′)、三尖瓣瓣环侧壁处舒张早期峰速(Et′)、室间隔瓣环处舒张早期峰速(Ei′)、二尖瓣瓣环侧壁处舒张晚期峰速(Am′)、三尖瓣瓣环侧壁处舒张晚期峰速(At′)、室间隔瓣环处舒张晚期峰速(Ai′)、二尖瓣瓣环侧壁处收缩期峰速(Sm′)、三尖瓣瓣环侧壁处收缩期峰速(St′)、室间隔瓣环处收缩期峰速(Si′)、Em/Am、Em/Em′、Em/Ei′、Et/Et′、肺动脉收缩压(SPAP)],以进一步分析需行ECMO治疗患者的特点。结果SM发病早期超声表现为左室整体或局部心肌回声不同程度的减低,室壁增厚率及运动幅度弥漫性下降。重症组的LAD、IVS、LVEDd、LVESd、心率、SPAP、Em/Am、Em/Em′、Em/Ei′高于健康组,而LVEF、Em′、Et′、Ei′、Am、Am′、At′、Ai′、Sm′、St′、Si′低于健康组,差异均有统计学意义(P<0.05)。ECMO组LVEDd和LVEF明显小于非ECMO组,差异有统计学意义(P<0.05);两组瓣环处组织收缩期峰速均明显低于正常水平,且ECMO组的Si′小于非ECMO组,差异有统计学意义(P<0.05)。结论超声心动图在SM发病早期即可快速诊断、判断严重程�Objective To explore the application value of echocardiography in the diagnosis and treatment of adult severe myocarditis(SM),and to provide an important reference for timely and effective clinical diagnosis and the application of extracorporeal membrane oxygenation(ECMO)adjuvant therapy.Methods A total of 29 SM patients hospitalized in the General Hospital of Northern Theater Command from September 2018 to December 2021 were selected as the critical group,and then divided into ECMO group(n=9)and non-ECMO group(n=20)according to whether or not they were treated with ECMO.Another 30 patients with normal physical examination results in the same age group were selected as the healthy group.The ultrasound parameters of the critical and healthy groups,as well as the ECMO and non-ECMO groups were compared to further analyze the characteristics of patients requiring ECMO treatment.The ultrasound parameters included left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),ventricular septum(IVS),left ventricular posterior wall thickness(LVPW),ventricular wall thickening rate,left ventricular ejection fraction(LVEF),mitral valve early diastolic peak velocity(Em),tricuspid valve early diastolic peak velocity(Et),mitral valve late diastolic peak velocity(Am),late diastolic peak velocity of tricuspid valve(At),early diastolic peak velocity of mitral ring(Em′),early diastolic peak velocity of mitral ring(Et′),early diastolic peak velocity of mitral ring(Ei′),late diastolic peak velocity of mitral ring(Am′),late diastolic peak velocity of tricuspid ring(At′),interventricular septum late diastolic peak velocity(Ai′),mitral peak systolic peak velocity(Sm′),tricuspid peak systolic peak velocity(St′),ventricular septal peak systolic peak velocity(Si′),Em/Am,Em/Em′,Em/Ei′,Et/Et′,pulmonary artery systolic blood pressure(SPAP).Results In the early stage of SM,the ultrasonography showed that the left ventricular echo was decreased in different degree

关 键 词：重症心肌炎 超声心动图 体外膜肺氧合 

分 类 号：R540.45[医药卫生—心血管疾病] R542.21[医药卫生—内科学]