急诊床边超声心动图对急性冠脉综合征的诊断价值再探(附95例报告)

Clinical values of bed-side echocardiography in assessing acute coronary syndrome:Report of 95 cases

目的 探讨急诊床边超声心动图 (BSUCG)在急性冠脉综合征 (ACS)中的临床价值。方法 95例ACS患者中 ,36例为 ST段抬高急性心肌梗死 (STEAMI) ,2 8例为非 ST段抬高急性心肌梗死 (NSTAEMI) ,31例为不稳定型心绞痛 (UA)。以 BSU CG及急诊床边心电图 (BSECG)评价心肌缺血或梗死 ,冠状动脉造影 (CAG)评价前降支 (L AD)、回旋支 (L CX)及右冠状动脉 (RCA)病变。结果 在 STEAMI和 NSTEAMI患者中 ,BSU CG及 BSECG均能较好地检出心肌梗死 ;在 UA患者中 ,胸痛发作时 BSUCG和 BSECG均可在多数患者检测出心肌缺血 ,而胸痛缓解后 BSUCG对心肌缺血检测的阳性率显著低于 BSECG(5 2 % VS94 % ,P<0 .0 5 )。BSUCG- BSECG-CAG三者检查的一致性在心尖部、高侧壁及下壁存在差异 ,BSECG对于心尖部心肌缺血存在检查“盲区”。若 L AD作为 ACS的“罪犯血管”,则 BSUCG对于“非罪犯血管” L CX和 RCA严重狭窄判断的准确性高达 88% ;若 L CX或 RCA作为 ACS的“罪犯血管”,则 BSUCG对于“非罪犯血管” L AD和 RCA或 L AD和 L CX严重狭窄判断的准确性分别为 75 %和 76 %。结论 BSU CG对 ACS心肌缺血及梗死的检测、范围确定及“非罪犯血管”严重狭窄推断方面具有肯定价值。

Objectives To evaluate the clinical values of emergency bed-side echocardiography(BSUCG)in assesing acute coronary syndrome.Methods Thirty-six patients with ST segmental elevation acute myocardial infarction(STEAMI),28 with non-ST segmental elevation acutemyocardial infarction(NSTEAMI)and 31 with unstable angina(UA)underwent BSUCG,bed-side electrocardiography(BSECG)and coronary angiography(CAG).Results In patients with STEAMI and NSTEAMI,and with UA and on going chest pain,both BSUCG and BSECG had high sensitivity for detecting myocardial ischemia or infarction,but in patients with UA and pain relieving BSUCG was lower sensitive than BSECG for detecting myocardial ischemia(52% VS 94%,P<0.05).BSECG was blind for detecting apical ischemiaor infarction.When LAD was the culprit vessel,the accuracy of BSUCG for indentifying severe LCX or RCA stenosis was 88%,and when LCX or RCA was the culprit vessel,the accuracy for predicting severe stenosis of LAD and RCA or LAD and LCX was 75% and 76%,respectively.Conclusions BSUCG is useful for detecting myocardial ischemia or infarction and predicting the existed non-culprit vessel stenosis in ACS.