实时三维超声心动图对急性心肌梗死经皮冠状动脉介入治疗前后左心室功能变化的评价

Change of Left Ventricular Function in Patients With Acute Myocardial Infarction Before and After PCI by RT- 3DE

目的探讨应用实时三维超声心动图(RT-3DE)评价急性心肌梗死患者经皮冠状动脉介入治疗(PCI)前后左心室局部功能变化的应用价值。方法选取2012年12月—2013年12月佳木斯大学附属第一医院接受PCI的急性心肌梗死患者46例为病例组,其中下后壁心肌梗死组27例,下壁心肌梗死组19例;另选择同时期体检中心体检健康者30例为对照组,对照组于体检时,病例组于PCI前、PCI后1、4、12周分别做RT-3DE检查,记录左心室各节段舒张末期容积(r EDV)及左心室各节段收缩末期容积(r ESV),并计算出各节段射血分数(r EF)。结果对照组RT-3DE左心室各节段容积-时间曲线规整有序,病例组患者PCI前RT-3DE左心室各节段容积-时间曲线杂乱无序。对照组与下后壁心肌梗死组PCI前及PCI后1周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF比较,差异有统计学意义(P<0.05);对照组与下后壁心肌梗死组PCI后4周下壁中间段、后壁中间段r EF比较,差异有统计学意义(P<0.05)。下后壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF比较,差异有统计学意义(P<0.05);其中PCI后1周后壁中间段r EF较PCI前升高(P<0.05);PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF较PCI前及PCI后1周升高(P<0.05);PCI后12周下壁中间段、后壁中间段r EF较PCI后4周升高(P<0.05)。对照组与下壁心肌梗死组PCI前、PCI后1周及PCI后4周下壁基底段、下壁中间段、下壁心尖段r EF比较,差异有统计学意义(P<0.05)。下壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段r EF比较,差异有统计学意义(P<0.05);其中PCI后4周及PCI后12周下壁基底段、下壁心尖段r EF较PCI前及PCI后1周升高(P<0.05);PCI后12周下壁中间段r EF较PCI前及PCI后1周升高(P<0.05)。结论 RT-3DE可较准确反映急性心肌梗死患者PCI前后左心室局部收缩功能的变化,可作为评价PCI疗效的有效方法。

Objective To investigate the application value of RT-3DE in the evaluation of the local function changes in the left ventricle of patients with acute myocardial infarction before and after percutaneous coronary intervention （ PCI ）. Methods Enrolled 46 patients with acute myocardial infartion who received PCI in the First Affiliated Hospital of Jiamusi University from December 2012 to December 2013 as the case group. The subjects who had myocardial infarction in the inferior posterior wall were assigned into inferior posterior wall group（n=27）,and the subjects who had myocardial infarction in thenbsp;inferior wall were assigned into the inferior wall group（n=19）. Another 30 healthy people who received physical examination in the same hospital during the same period were enrolled as the control group. The control group received RT-3DE during physical examination,and the case group received RT-3DE before PCI and at week 1,week 4 and week 12 after PCI,then rEDV and rESV of each segment of the left ventricular were recorded and the rEF of each segment was calculated. Results The RT-3DE volume-time curves were regular and ordered in each segment of left ventricular in the control group and were irregular and disordered in the case group. The control group and the inferior posterior wall group were significantly different（P〈0. 05）in the rEF of inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment before PCI and at week 1 after PCI. The control group and the inferior posterior wall group were significantly different（ P〈0. 05）in the rEF of inferior middle segment and posterior middle segment at week 4 after PCI. Before PCI and at week 1,4, 12 after PCI were significantly different（P〈0. 05）in the rEF of inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment in the inferior posterior wall group;the inferior posterior wall group had higher（P〈0. 05）rEF in posterior middle segment at week 1 after PCI than that before PCI;the inferior posterior wall group had higher（P〈0. 05）rEF in inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment at week 4 and week 12 after PCI than that before PCI and at week 1 after PCI;the inferior posterior wall group had higher（P〈0. 05）rEF in inferior middle segment and posterior middle segment at week 12 after PCI than that at week 4 after PCI. The control group and the inferior wall group were significantly different（P〈0. 05）in the rEF of inferior basal segment,inferior middle segment and inferior vertex segment before PCI and at week 1 and week 4 after PCI. Before PCI and at week 1,4,12 after PCI were significantly different（P 〈0. 05）in the rEF of inferior basal segment,inferior middle segment and inferior vertex segment in the inferior wall group;the inferior wall group had higher（P〈0. 05）rEF in inferior basal segment and inferior vertex segment at week 4 and week 12 after PCI than that before PCI and at week 1 after PCI;the inferior wall group had higher（P〈0. 05）rEF in inferior middle segment at week 12 after PCI than that before PCI and at week 1 after PCI. Conclusion RT-3DE can accurately reflect the changes of local systolic function of left ventricular after PCI and can be used as an effective method of evaluating the curative effect of PCI.