小剂量多巴酚丁胺负荷超声心动图对心肌梗死后存活心肌识别的临床研究

The clinical study of viable myocardium after myocardial infarction by low-dose dobutamine stress echocardiography

目的利用小剂量多巴酚丁胺负荷超声心动图(LDDSE)对心肌梗死后存活心肌的识别,评价经皮冠状动脉介入治疗(PCI)效果。方法 36例冠心病心肌梗死患者,行LDDSE检查,将其分为有存活心肌组和无存活心肌组,所有患者均行PCI手术,测量各项超声指标。结果 36例冠心病心肌梗死患者有277个节段有运动异常,PCI术前有存活心肌组的收缩压(SBP)、舒张压(DBP)高于无存活心肌组(P<0.01),左室收缩末期内径(LVEDd)、左室舒张末期内径(LVESd)、左房内径(LAd)小于无存活心肌组(P<0.05),E/A值、左室射血分数(LVEF)差异均无统计学意义(P>0.05),PCI术后,有存活心肌组LVEDd、LVESd、LAd小于PCI术前,E/A值、LVEF大于术前(P<0.05)。无存活心肌组各项指标差异无统计学意义(P>0.05)。结论对于冠心病心肌缺血或梗死区域内有存活心肌的患者,再血管化后局部心肌功能恢复或改善,无存活心肌患者,行血管再通术则无明显意义。

Objective： To identify survival myocardium after myocardial infarction by the use of low-dose dobutamine stress echocardiography（ LDDSE）,and evaluate the effect of coronary artery intervention（ PCI）. Methods： Totally 36 coronary heart disease（ CHD） patients with myocardial infarction were studied. All patients were divided into myocardial survival group and no myocardial survival groups according to the LDDSE test,and all patients were given PCI surgery,measuring the ultrasonic indexes. Results： In the 36 patients with coronary heart disease,there were 277 segmental motion abnormalities. PCI preoperative,systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） in survival myocardium group were higher than those in the no myocardial survival group（ P〈0. 01）,left ventricular end systolic diameter（ LVEDd）,left ventricular end- diastolic diameter（ LVESd）,left atrial diameter（ LAd） were less than those in the no myocardial survival group（ P〈0. 05）,and there was no statistically significant difference in E / A value,left ventricular ejection fraction（ LVEF）（ P〈0. 05）. Compared with the PCI postoperative,LVEDd,LVESd and LAd were less than the PCI preoperative,and E / A value and LVEF were greater than the PCI preoperative in survival myocardium group（ P〈0. 05）. There was no statistical significance in no myocardial survival group（ P〈0. 05）. Conclusion： For the patients who have myocardial ischemia in coronary heart disease or have survival myocardium in infarction area,local myocardial functional can recover or improve after vascularization again,but vascular recanalization is not significant for the patients without survival myocardium.