多普勒超声心动图对急性心肌梗塞患者溶栓治疗的评价

Evaluation of thrombolytic therapy in patients with acute myocardial infarction by Doppler echocardiography

目的：探讨多普勒超声心动图对不同梗塞部位急性心肌梗塞（ＡＭＩ）溶栓治疗再通评价的意义。方法：对１６０例首次ＡＭＩ患者随机分成尿激酶溶栓治疗再通组和常规治疗对照组，采用彩色多普勒超声心动图测定左房内径（ＬＡＤ）、室间隔和左室后壁运动最小幅度（ＩＶＳＡ和ＬＶＰＷＡ）、左室射血分数（ＥＦ）、二尖瓣Ｅ点至室间隔距离（ＥＰＳＳ）和二尖瓣血流频谱Ａ峰最大速度与Ｅ峰最大速度比（Ａ／Ｅ）。结果：①溶栓治疗者再通率为５８．８２％（７０／１１９）。②急性前壁心肌梗塞（ＡＡＭＩ）患者的ＬＡＤ、ＥＰＳＳ和Ａ／Ｅ在溶栓组明显低于对照组（Ｐ＜０．０１，Ｐ＜０．０１，Ｐ＜０．０１）；溶栓再通组ＥＦ明显高于对照组（Ｐ＜０．０１）。③急性下壁心肌梗塞（ＡＩＭＩ）患者ＬＶＰＷＡ溶栓再通组高于对照组（Ｐ＜０．０５）；溶栓再通组Ａ／Ｅ明显低于对照组（Ｐ＜０．０１）。④ＡＡＭＩ＋ＡＩＭＩ患者ＥＦ在溶栓再通组明显高于对照组（Ｐ＜０．０１）；ＥＰＳＳ低于对照组（Ｐ＜０．０５）。结论：溶栓治疗可限制梗塞面积，挽救濒死心肌，改善左室功能。在梗塞部位上，前壁优于下壁，ＡＡＭＩ＋ＡＩＭＩ介于两者之间。

Objective:To investigate the significance of evaluating the reperfusion effectiveness by Doppler echocardiography in acute myocardial infarction (AMI) of various sites following intravenous thrombolysis.Methods:One hundred and sixty patients with first attack of AMI were randomized into intravenous thrombolysis reperfusion group and conventionally treated group(controls).Left atrial dimension (LAD),interventricular septum minor motion amplitude (IVSA),left ventricular posterior wall minor motion amplitude (LVPWA),left ventricular ejection fraction (EF),Epoint septal separation (EPSS) and A/E were studied by Doppler echocardiography.Results:Reperfusion rate was 58.82% (70/119) in patients treated with intravenous thrombolysis.Compared with control group,LAD,EPSS,A/E in patients with acute anterior myocardial infarction (AAMI) were significantly reduced(all P <0 01),and EF was significantly increased after thrombolytic therapy ( P <0 01).It was also found that LVPWA in patients with acute inferior myocardial infarction (AIMI) was significantly increased and A/E was markedly reduced following thrombolysis compared with controls ( P <0 05￣0 01).Moreover,EF in patients with AAMI and AIMI was significantly increased and EPSS was significantly reduced in thrombolysis treated group compared with controls ( P <0 05￣0 01).Conclusions:These results suggest that thrombolytic therapy may play a significant role in reducing infarct size and improving left ventricular function.In addition,effectiveness would be better in patients with AAMI than those with AIMI after thrombolytic therapy.