心肌声学造影在急性心肌梗死患者中的临床应用  

Clinical application in patients with acute myocardial infarction by myocardial contrast echocardiography using intravenously infused Levovist

作　　者：赵静[1] 张运[1] 季晓平[1] 张薇[1] 张梅[1] 钟明[1] 葛志明[1] 

机构地区：[1]山东大学齐鲁医院心内科,济南250012

出　　处：《中华超声影像学杂志》2003年第12期720-723,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目( 6 0 0 72 0 2 2 )

摘　　要：目的　探讨利声显经静脉心肌声学造影 (IMCE)在急性心肌梗死 (AMI)的诊断、溶栓疗效的评价和室壁运动恢复的预测等方面的价值。方法　 13例AMI患者于溶栓前后分别进行IMCE检查 ,描划出时间 强度曲线 ,测量平台期的心肌显像最大强度A、曲线上升至A的平均斜率 β及A与 β之积在溶栓前后的变化。随访 3个月 ,判定IMCE各项指标预测左心室功能恢复的情况。结果　溶栓后梗死节段的A、β及A·β均较溶栓前差异有显著性意义 (P <0 .0 0 1)。相关分析显示 ,随访期室壁运动记分指数与溶栓后 A、β、A·β相关良好 (r=-0 .70 ,-0 .59和 -0 .66,P <0 .0 5) ,其中与 A 相关性最好。以 A =4分作为心肌再灌注的标准 ,对室壁运动的恢复具有较高的预测准确性。结论　利声显IMCE可实现AMI患者溶栓疗效的即刻评价 。Objective To study the clinical application s of intravenous myocardial contrast echocardiography (IMCE) in assessing myocardial reperfusion in acute myocardial infarction (AMI) using intravenously infused Levovist. Methods IMCE was performed in 13 AMI patients before and after thrombolytic therapy. The power Doppler signals of the myocardial segments were analyzed and the time-amplitude curves were plotted during Levovist infusion and incremental triggering. The maximal amplitude score (A), the mean ascending slope of the curve(β) and the product of A·β were measured. All patients were followed up for 3 months. And then IMCE indices were estimated for left ventricular function. Results There was a significant increase in A,β and A·β between before and after thrombolysis(P< 0.001 ). Good correlations were found between WMSI and A,β and A·β, while wall motion score index correlated best with A (r= -0.70 , P< 0.05 ). Further analysis on the different score of A in predicting the improvement of left ventricular function, A≥4 was found to have the best predictive accuracy. Conclusions IMCE offers a simple and reliable approach to the non-invasive assessment of thrombolytic therapy in patients with AMI, which can also be used to assess the microcirculation integrity and predict improvement of LV function.

关 键 词：心肌声学造影 急性心肌梗死 诊断 超声心动描记术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R697.25[医药卫生—诊断学]