超声二次谐波心肌声学造影评价心肌的血流灌注

Detection of Myocardial Perfusion Evaluated by Second Harmonic Myocardial Contrast Echocardiography with Intravenous Injection of Microbubbles

目的 :探讨心肌声学造影对冠状动脉 (冠脉 )病变的诊断价值。 方法 :静脉注射声学造影剂利声显 (levovist) ,通过超声二次谐波技术获取心肌灌注图像 ,对比冠脉造影显示的冠脉支配区域的心肌灌注与超声心肌声学造影获取的心肌灌注类型的关系。按心肌灌注积分指数将异常冠脉分为 3组 ,心肌灌注积分指数 1分 (A组 ,2 7支 ) ,2分≥心肌灌注积分指数 >1分 (B组 ,2 4支 ) ,>2分 (C组 ,33支 )。 结果 :心肌灌注积分指数与冠脉狭窄度呈中度正相关 (r=0 .75 ,P<0 .0 0 1) ,3组病人的冠脉狭窄程度、心肌灌注积分指数明显差异 (P<0 .0 0 1)。冠脉狭窄度 <75 %者 ,病人室壁灌注多为正常 ,随着冠脉狭窄程度加重 ,室壁灌注出现异常。 结论 :静脉心肌声学造影是反映心肌灌注的有效方法 ,能够反应冠脉血流的改变及微循环结构的完整性变化 ,从而弥补了冠脉造影仅能显示心外膜下的冠脉而无法观察毛细血管水平心肌灌注的缺限。

Objective:To assess the relation between the myocardial perfusion and the coronary artery disease using second harmonic myocardial contrast echocardiography by intravenous levoist. Methods:Thirty six patients finished the coronary artery angiography and myocardial contrast echocardiography(MCE).The diseased artery were classified as three groups according the perfusion score.Ten myocardial segment (5 each in the apical two and four chamber views) from the images were scored for evaluation of myocardial perfusion. Results:Correlation between the myocardial perfusion score index and coronary stenosis rate was moderate ( r =0 75, P <0 001).There are significant difference among the different perfusion groups and coronary disease ( P <0 001).The conditions of myocardial perfusion of 8 total occluded arteries were different because of different amount of collateral circulation. Conclusions:There are close relationship between the coronary artery stenosis and MCE myocardial perfusion.We can also use MCE to evaluate the coronary artery recanalization,prognostic for risk area and collateral circulation.