心导纳微分环在急性心肌梗死患者中的临床应用  

Clinical Application of CADL in the Patients with Acute Myocardial Infarction

作　　者：谢旭晶[1] 陈璘[1] 刘金来[1] 赵长林[1] 钱孝贤[1] 彭朝权[1] 周汉健[1] 

机构地区：[1]中山大学附属第三医院心内科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2003年第3期298-302,共5页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨心导纳微分环(CADL)在评价急性心肌梗死(AMI)患者治疗前后冠状动脉供血、心功能变化和预测临床转归的作用。【方法】AMI患者33例,根据治疗方法分为静脉溶栓组(n=21)和非溶性组(n=12),分别对两组患者进行CADL检测,具体指标有Ⅰ相环体切迹、射血前间期与左室射血时间比值(r_(PEP/LVET))、Ⅰ+Ⅱ相面积百分比[(Ⅰ+Ⅱ)%]、Ⅲ相与Ⅰ+Ⅱ相面积比值(r_(Ⅲ/Ⅰ+Ⅱ))、Ⅴ相与Ⅰ+Ⅱ相面积比值(r_(/ⅤⅠ+Ⅱ)),动态观察治疗前及治疗后4周内CADL的变化,并与同期临床症状、心电图(ECG)、肌酸磷酸激酶(CK-MB)比较。选择40例健康成年人作为对照组。【结果】溶栓组临床症状逐渐好转18例,CADL均显示好转:Ⅰ相环体切迹变浅至消失,r_(PEP/LVET)平均由0.46±0.15下降至0.32±0.12,(/Ⅰ+Ⅱ)％由60.24％±12.15％上升至87.37％±13.28％,r_(Ⅲ/Ⅰ+Ⅱ)由0.23±0.18下降至0.08±0.03,r_(Ⅴ/Ⅰ+Ⅱ)由0.37±0.34下降至0.10±0.05;发生心源性死亡3例,CADL指标均恶化:Ⅰ相环体切迹加深,r_(PEP/LVET)由0.47±0.16上升至0.59±0.18;(Ⅰ+Ⅱ))％由63.20％±13.05％下降至32.80％±17.50％,r_(Ⅲ/Ⅰ+Ⅱ)由0. 24±0.16上升至0.41±0.25,r_(Ⅴ/Ⅰ+Ⅱ)由0.38±0.36上升至0.47±0.38;而其中2例的ECG、CK-MB变化呈好转趋势。[Objective] To investigate the clinical value of cardiac admittance differential loop (CADL) in reflecting the changes of coronary flow and cardiac function and predicting the outcome of the patients with acute myocardial infarction (AMI). [Methods] 33 patients with definite diagnosis of AMI were selected, in which 21 patients with intravenous thrombolysis and 12 patients without thrombolysis . CADL were tested for four weeks and compared with clinical symptom, ECG and CK-MB. 40 healthy adults were selected as the control group. [Results] CADL of eighteen patients in intravenous thrombolysis group ameliorated gradually which were consistent with short - term clinical outcome: the notch in phase I lessened, even disappeared, the ratio of pre - ejection period to left ventricular ejection time( TPEP/LVET) decreased from 0. 46 ± 0. 15 to 0. 32 ±0. 12, the ratio of area of phase Ⅰ + Ⅱ to total area[ ( Ⅰ + Ⅱ)% Jincreased from 60. 24% ± 12. 15% to 87. 37% ± 13. 28%, the ratio of area of phase Ⅲ to area of Ⅰ + Ⅱ ( rⅢ/Ⅰ+Ⅱ) decreased from 0. 23 ± 0. 18 to 0. 08 ± 0. 03, the ratio of area of phase V to area of Ⅰ+Ⅱ(rⅤ/Ⅰ+Ⅱ) decreased from 0. 37 ± 0. 34 to 0. 10 ±0. 05. Three patients died of cardiogenic death whose CADL deteriorated. In the non - thrombolysis group, the changes of CADL were consistent with short - term outcome. The positivity of notch in phase I (84. 8% ) were higher than ECG(81. 8% ) but there was no difference between them. [ Conclusion] The changes of CADL could reflect indirectly the changes of myocardial blood supply and cardiac function of the patients with AMI. Dynamic observation of CADL had practical value to evaluate the treatment and the short - term prognosis of the patients with AMI.

关 键 词：心导纳微分环 急性心肌梗死 心功能 心血管容积 心源性死亡 

分 类 号：R540.4[医药卫生—心血管疾病]