超声心动图检测室壁节段性运动异常与室壁冠脉血供对应关系的研究

The analysis of correlation between regional wall motion abnormality detected by echocardiography and vascular distribution

目的探讨常规超声心动图检测的室壁节段性运动异常与冠脉血供分布的对应关系。方法对150例心肌梗死患者进行回顾性分析,全部病例均行冠脉造影示单支或多支病变。超声心动图利用左室16节段法通过多切面检测各室壁节段性运动异常并对其进行评价。结果①150例心肌梗死患者中,室壁节段性运动异常134例,阳性率89.3%,检测心肌缺血的敏感性随病变支数的增加而增加,对非ST段抬高型心梗诊断率低。②室壁节段性运动异常与病变血管支配的供血区域较一致,侧壁、后间隔中段一致性程度低。③超声心动图与冠脉造影检测冠脉单支及多支病变的例数差异无统计学意义(P<0.05);UCG检测病变血管的准确性较高,检测出左前降支和右冠状动脉的敏感性(73.9%、75.0%)较左回旋支(54.7%)高,P<0.05。结论超声心动图是诊断冠心病特别是心肌梗死的一种无创、安全、重复性好、价格低廉的方法,通过其检测的节段性室壁运动异常可以较准确地推断出心肌缺血的血管部位,可将其作为临床评价心肌缺血和(或)心肌梗死有无的早期敏感指标。

Objective To explore the correlation between regional wall motion abnormality by echocardiography and vascular distribution. Methods 150 patients with myocardial infarction were retrospectively analyzed; All cases were shown single or multiple lesions by coronary arteriography. Standard short and long axis image of left ventricle were measured by using echocardiography and it was displayed regional wall motion abnormality. Results Regional wall motion abnormality in 134 cases （89.3%） with myocardial infarction was displayed ; The more number of lesions, the more sensitive echocardiography diagnosed myocardial ischemia, but diagnosed USTEMI was lower; Regional wall motion abnormality of left ventricular was in accordance with the area that pathological vessel dominate, and lateral wall and interlude of posterior ventricular septum was lower in consistent degree; There was no significant difference between the two methods in judging all of the single and multiple branches of arteries （ P 〈 0.05 ）. the sensitivity in detecting left anterior artery disease and right artery disease （73.9%, 75.0% ） exceeded left circumflex disease （54.7%, P 〈 0.05 ）. Conclusion Echocardigraphy is a convenient, noninvasive method and cheaper method to diagnose myocardial infarction, which can accurately to infer the vascular of myocardial ischemia, we can consider it as a early sensitive index to evaluate myocardial ischemia and/or myocardial infarction.