三维经食管超声心动图对冠心病合并中重度缺血性二尖瓣反流内科治疗的近期疗效分析  

Recent Efficacy of Three-dimensional Ransesophageal Echocardiography in the Medical Management of Coronary Artery Disease Combined with Moderate-to-severe Ischemic Mitral Regurgitation

作　　者：肖雨雄 李琳 邓芸 陈宝峰 XIAO Yuxiong;LI Lin;DENG Yun;CHEN Baofeng(Department of Ultrasonography,Yuebei People's Hospital,Shantou University Medical College,Guangdong 512000,China;Department of Cardiology,Yuebei People's Hospital,Shantou University Medical College,Guangdong 512000,China)

机构地区：[1]汕头大学医学院附属粤北人民医院超声诊断科,广东5120002 [2]汕头大学医学院附属粤北人民医院心内科,广东5120002

出　　处：《影像技术》2025年第2期17-23,共7页Image Technology

基　　金：韶关市科技局支持科研工作者立项项目(220914166576697);韶关市卫生健康科研项目(Y22105)。

摘　　要：目的:缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)是冠心病常见的并发症之一,其严重程度与心脏不良事件的发生密切相关,如何正确处理和评估IMR,已成为改善患者预后的关键,本研究旨在利用3D-TEE分析中重度二尖瓣反流冠心病患者药物治疗效果,并探讨其对治疗方案的影响。方法:利用3D-TEE对我院心内科、心外科收治的中重度二尖瓣反流冠心病患者81例及20例正常对照者进行检查,测量常规心脏参数后应用MVQ软件测量中重度二尖瓣反流冠心病患者治疗前及治疗后二尖瓣叶、瓣环解剖形态学参数,分析其变化特点。所有患者根据通过药物规范治疗2~3周后治疗效果分为W、H两组,治疗后其反流量无明显变化者55例为W组,反流量减轻至中度以下者26例为H组,收集W、H组及对照组患者常规超声心动图、3D-TEE测量数据。结果:治疗前研究组左室大小、LVEF与对照组总体有显著差异(P<0.05),H组患者经治疗后左室大小较治疗前缩小、LVEF较治疗前升高(P<0.05),治疗后与正常人群无统计学差异(P>0.05);治疗前研究组二尖瓣三维参数与对照组总体有显著差异(P<0.05),H组患者治疗后:二尖瓣环前外后内侧直径(DALPm)、瓣环前后径(DAP)、瓣环周长(C3D)、瓣环的最小三维面积(A3Dmin)、环绕椭圆度(E2D)较治疗前缩小(P<0.05),瓣环高度(AH)、瓣环高度与前外后内侧直径的比率(H/DAIPm)、瓣叶投影平面中的前外后内侧直径(L2DALPm)较治疗前增加(P<0.05),治疗后与正常人群无统计学差异(P>0.05)。结论:3D-TEE利用高频探头近距离探查能够精准评估二尖瓣复合体解剖结构,不受气体、肥胖等因素影响,可以准确评价冠心病合并中重度IMR患者进行规范的药物治疗前、后二尖瓣瓣叶、瓣环的结构特征,评估IMR的预后,指导下一步的临床治疗;通过对治疗前后患者的3D-TEE检查,发现IMR反流程度减轻的患者左室重构减轻,左室�Objective:Ischemic mitral regurgitation(IMR)is one of the common complications of coronary artery disease,and its severity is closely related to the occurrence of adverse cardiac events,how to correctly manage and evaluate IMR has become the key to improve the prognosis of patients.The aim of this study is to analyze the effect of drug therapy in patients with moderate-to-severe mitral regurgitation coronary artery disease by using 3D-TEE,and to explore the effect of its impact on the treatment plan.Methods:3D-TEE was used to examine 81 patients with moderate and severe mitral regurgical CHD admitted to the Department of Cardiology and the Department of Cardiology in our hospital,and 20 normal controls.After measuring routine heart parameters,MVQ software was used to measure the anatomic and morphology parameters of mitral lobes and ring of mitral regurgical CHD patients before and after treatment,and to analyze their changes.All patients were divided into W and H groups according to the treatment effect after 2 to 3 weeks of standardized drug treatment.55 cases with no significant change in the reverse flow rate after treatment were classified as group W,and 26 cases with the reverse flow rate reduced to less than moderate were classified as group H.Routine echocardiography and 3D-TEE measurement data of patients in groups W,H and control group were collected.Results:(1)Before treatment,there were significant differences in left ventricular size and LVEF between the study group and the control group(P<0.05).After treatment,left ventricular size decreased and LVEF increased in the H group compared to before treatment(P<0.05),but there was no statistically significant difference compared to the normal population after treatment(P>0.05).(2)Before treatment,the three-dimensional parameters of mitral valve in the study group were significantly different from those in the control group(P<0.05),after treatment,in group H,diameter of the anterior,lateral,posterior,and medial regions of the mitral annulus(DALPm),diameter

关 键 词：冠心病 缺血性二尖瓣反流 三维经食管超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学]