无创心肌做功参数评价急性心肌梗死合并心源性休克患者主动脉内球囊反搏治疗早期左心室收缩功能变化

Non-invasive myocardial work indexes in evaluating left ventricular systolic function in early stage of intra-aortic balloon pump in patients with acute myocardial infarction and cardiogenic shock

目的观察急性心肌梗死合并心源性休克患者行主动脉内球囊反搏(intra-aortic balloon pump counterpulsation,IABP)治疗前及治疗早期常规超声心动图参数及无创心肌做功参数变化,探讨无创心肌做功参数评价IABP治疗早期左心室收缩功能的价值。方法急性心肌梗死合并心源性休克患者36例为观察组,均行IABP治疗,同期体检健康者36例为对照组。分别于观察组IABP治疗前、治疗1 h时及对照组体检时行常规超声心动图检查,测量心率、左心房前后径、左心室舒张末期容积、左心室收缩末期容积,分析左心室整体纵向应变,计算心肌做功参数(包括整体做功指数、整体有用功、整体无用功、整体做功效率)。采用Pearson相关法分析观察组患者IABP治疗1 h时整体无用功、整体做功效率与左心室收缩末期容积、左心室舒张末期容积的相关性。结果观察组IABP治疗前心率[(77.3±15.8)次/min]、收缩压[(121.9±14.9)mm Hg]、左心室舒张末期容积[(134.8±32.1)mL]、左心室收缩末期容积[(57.0±11.9)mL]、左心室整体纵向应变[(-12.6±4.2)%]均高于对照组[(62.6±4.9)次/min、(116.2±4.6)mm Hg、(100.9±14.5)mL、(35.6±6.0)mL、(-19.0±2.8)%](P<0.05),舒张压[(58.2±9.4)mm Hg]低于对照组[(71.6±3.3)mm Hg](t=11.312,P=0.001)左心房前后径与对照组比较差异无统计学意义(P>0.05)。观察组IABP治疗前整体做功指数[(1073.3±488.9)mm Hg%]、整体有用功[(1268.4±514.4)mm Hg%]、整体做功效率[(82.3±10.1)%]均低于对照组[(1970.2±153.8)mm Hg%、(2205.0±204.8)mm Hg%、(97.3±0.9)%](P<0.05),整体无用功[(187.5±81.6)mm Hg%]高于对照组[(43.0±16.0)mm Hg%](t=10.418,P<0.001)。观察组IABP治疗1 h时整体无用功[(150.0±78.1)mm Hg%]低于IABP治疗前[(187.5±81.6)mm Hg%](t=-3.051,P=0.004),整体做功效率[(84.2±11.0)%]高于IABP治疗前[(82.3±10.1)%](t=2.410,P=0.021),整体做功指数、整体有用功、左心室整体纵向应变、左心室收缩末期容积、左心室舒张末期容积与IABP治疗前比较差异均无统计学意义(P>0.05)。观察组患者IABP治疗1 h时整体无用功与左心室收缩末期容积、左心室舒张末期容积呈正相关(r=0.639,P<0.001;r=0.623,P<0.001),整体做功效率与左心室收缩末期容积、左心室舒张末期容积呈负相关(r=-0.741,P<0.001;r=-0.943,P<0.001)。结论无创心肌做功参数可在IABP治疗早期无创、定量评估急性心肌梗死合并心源性休克患者左心室心肌做功情况。

Objective To observe the changes of conventional echocardiographic parameters and non-invasive myocardial work indexes in patients with acute myocardial infarction complicated with cardiogenic shock before and in the early stage of intra-aortic balloon pump(IABP),and to investigate the value of non-invasive myocardial work indexes to the evaluation of left ventricular systolic function in the early stage of IABP.Methods Thirty-six patients with acute myocardial infarction complicated with cardiogenic shock were treated with IABP(observation group)and another 36healthy volunteers in the same period were as controls(control group).The heart rate,left atrial anteroposterior diameter,left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were measured by conventional transthoracic echocardiography before and in 1hafter IABP in observation group and during physical examination in control group.The global longitudinal strain(GLS)was analyzed and the global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)were calculated.Pearson correlation was used to analyze the correlations of GWW and GWE with LVEDV and LVESV 1h after IABP in observation group.Results Before IABP,the heart rate[(77.3±15.8)beats/min],systolic blood pressure[(121.9±14.9)mm Hg],LVEDV[(134.8±32.1)mL],LVESV[(57.0±11.9)mL]and GLS[(-12.6±4.2)%]in observation group were higher than those in control group[(62.6±4.9)beats/min,(116.2±4.6)mm Hg,(100.9±14.5)mL,(35.6±6.0)mL,(-19.0±2.8)%](P<0.05),the diastolic blood pressure[(58.2±9.4)mmHg]was lower than that in control group[(71.6±3.3)mm Hg](t=11.312,P=0.001),and there was no significant difference in left atrial anteroposterior diameter between two group(P>0.05).Before IABP,the GWI[(1073.3±488.9)mm Hg%],GCW[(1268.4±514.4)mm Hg%]and GWE[(82.3±10.1)%]in observation group were lower than those in control group[(1970.2±153.8)mm Hg%,(2205.0±204.8)mm Hg%,(97.3±0.9)%](P<0.05),and the GWW[(187.5±81.6)mm Hg%]was higher than that in control group[(43.0±16.0)mm Hg%](t=10.418,P<0.001).The GWW was lower and the GWE was higher 1hafter IABP[(150.0±78.1)mm Hg%,(84.2±11.0)%]than that before IABP[(187.5±81.6)mm Hg%,(82.3±10.1)%]in observation group(t=-3.051,P=0.004;t=2.410,P=0.021),and there were no significant differences in the GWI,GCW,LVGLS,LVEDV and LVESV after IABP(P>0.05).In 1hafter IABP in observation group,the GWW was positively correlated with the LVESV and LVEDV(r=0.639,P<0.001;r=0.623,P<0.001),and the GWE was negatively correlated with the LVESV and LVEDV(r=-0.741,P<0.001;r=-0.943,P<0.001).Conclusion Non-invasive myocardial work indexes can be used to non-invasively and quantitatively assess the left ventricular myocardial work in the early stage of IABP in patients with acute myocardial infarction complicated with cardiogenic shock.