彩超对急性心肌梗死患者亚急性左室游离壁破裂的诊断及预后评估价值分析

The Value of Color Doppler Flow Imaging in the Diagnosis and Prognosis evaluation of subacute left ventricular Wall Rupture in Patients with acute myocardial Infarction

目的探讨彩超对急性心肌梗死(AMI)患者亚急性左心室游离壁破裂(LVWR)的诊断及预后评估价值。方法对河南科技大学第一附属医院2017年1月至2021年12月收治的62例急性心肌梗死患者展开研究,根据患者伴或不伴亚急性左室游离壁破裂进行分组观察,对比两组一般资料、超声图像特征(包括心包积液出现时间、心包积液量、有无回声),再对急性心肌梗死伴亚急性左室游离壁破裂患者超声图像中有无回声进行最后随访观察,统计两组1年内死亡率情况。结果AMI患者中共有15例发生亚急性LVWR,发生率为24.19%,AMI伴亚急性LVWR一般资料中收缩压高于不伴亚急性LVWR患者,差异有统计学意义(P<0.05),其余指标差异均无统计学意义(P>0.05);AMI伴亚急性LVWR患者的心包积液出现时间短于AMI不伴亚急性LVWR,心包积液量高于AMI不伴亚急性LVWR患者,出现回声的人数占比高于AMI不伴亚急性LVWR,差异有统计学意义(P<0.05);随访3~6个月,AMI伴亚急性LVWR心包积液有回声与无回声患者的死亡率相比差异均无统计学意义(P>0.05),但至1年时,AMI伴亚急性LVWR心包积液有回声患者的死亡率高于无回声者,差异有统计学意义(P<0.05)。结论彩超技术在观察急性心肌梗死后并发亚急性左心室游离壁破裂中具有重要作用,尤其是通过观察心包积液及有无心肌回声能为疾病诊断及预后评估提供重要线索。

Objective To explore the value of color doppler flow imaging in the diagnosis and prognosis evaluation of subacute left ventricular wall rupture(LVWR)in patients with acute myocardial Infarction(AMI).Methods A total of 62patients with acute myocardial infarction admitted to the First Affiliated Hospital of Henan University of science and technology from January 2017 to December 2021 were studied.According to the patients with or without subacute left ventricular wall rupture,they were grouped and observed.The general data and ultrasonic image characteristics(including the occurrence time of pericardial effusion,the amount of pericardial effusion,and the presence or absence of echo)of the two groups were compared,Then the echo in the ultrasonic images of patients with acute myocardial infarction and subacute left ventricular wall rupture were followed up and observed,and the mortality of the two groups within one year was counted.Results There were 15 cases of subacute LVWR in AMI patients,the incidence rate was 24.19%.The systolic blood pressure of AMI patients with subacute LVWR was higher than that of patients without subacute LVWR,the difference was statistically significant(P<0.05),and the difference of other indexes was not statistically significant(P>0.05);The occurrence time of pericardial effusion in AMI patients with subacute LVWR was shorter than that in AMI patients without subacute LVWR,the amount of pericardial effusion was higher than that in AMI patients without subacute LVWR,and the proportion of echo was higher than that in AMI patients without subacute LVWR(P<0.05);During the follow-up period of 3-6 months,there was no significant difference between the mortality of echogenic and non-echogenic patients with AMI and subacute LVWR pericardial effusion(P>0.05),but by 1 year,the mortality of echogenic patients with AMI and subacute LVWR pericardial effusion was higher than that of non-echogenic patients(P<0.05).Conclusion Color doppler ultrasound plays an important role in the observation of subacute left ventricular wall rupture after acute myocardial infarction,especially through the observation of pericardial effusion and myocardial echo,it can provide important clues for disease diagnosis and prognosis evaluation.