右冠状动脉慢性闭塞合并陈旧下壁心肌梗死病人右心功能的评价

发布时间：2018-04-23 16:00

本文选题：超声心动图 + 右冠状动脉慢性闭塞　；参考：《首都医科大学学报》2017年04期

【摘要】：目的用二维超声心动图观察右冠状动脉(right coronary artery,RCA)慢性完全闭塞病变(chronic total occlusion,CTO)合并陈旧下壁心肌梗死病人右心功能的变化情况并探讨其临床意义。方法首都医科大学附属北京安贞医院2013年6月至2016年10月收治的28例RCA-CTO合并陈旧下壁心肌梗死病人,根据冠状动脉造影结果分为侧支循环良好组和侧支循环不良组,术前应用超声心动图测量2组右心室面积变化率(right ventricular fractional area change,RVFAC)、三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、心肌综合指数(myocardial performance index,MPI),多普勒超声心动图测量三尖瓣口舒张期血流速度(E、A峰值),组织多普勒(tissue Doppler imaging,TDI)测量三尖瓣环舒张期运动速度(e’及a’值),比较2组临床特点、介入手术情况、术后心血管不良事件发生情况和平均住院时间。结果 2组比较,侧支循环不良组术前RVFAC、TAPSE较低,MPI、E/A比值及E/e’比值较高,提示侧支循环不良组较侧支循环良好组右室收缩及舒张功能均下降(P0.05);2组介入手术情况比较,侧支循环良好组术中严重心律失常发生0例,侧支循环不良组术中严重心律失常发生8例,占44.4%,2组差异有统计学意义(P0.05);术后发生严重心律失常在侧支循环良好组中有0例,侧支循环不良组有7例占38.9%,差异有统计学意义(P0.05);2组平均住院天数比较,侧支循环不良组住院时间较长(P0.05)。结论 RCA-CTO合并陈旧下壁心肌梗死病人侧支循环形成不良较侧支循环形成良好者右心功能下降明显,术前二维超声心动图对此类病人右心功能的评估可以评价此类病人侧支循环形成良好与不良之间的差异,具有一定的临床意义。
[Abstract]:Objective to observe the changes of right ventricular function in patients with chronic total occlusion of right coronary artery (RCA) and inferior wall myocardial infarction (AMI) by two dimensional echocardiography and to explore its clinical significance. Methods from June 2013 to October 2016, 28 patients with RCA-CTO complicated with obsolete inferior wall myocardial infarction were treated in Beijing Anzhen Hospital affiliated to Capital Medical University. According to the results of coronary angiography, they were divided into two groups: good collateral circulation group and bad collateral circulation group. Right ventricular fractional area change rate, tricuspid annular plane systolic excursion, myocardial complex index myocardial performance index MPII and tricuspid annular plane systolic excursion were measured by echocardiography before operation. Doppler echocardiography was used to measure the diastolic velocity of tricuspid valve. The diastolic velocities of tricuspid annulus were measured by tissue Doppler imaging (TDI), and the clinical characteristics of the two groups were compared. Interventional surgery, postoperative cardiovascular adverse events and the average length of hospital stay. Results compared with the two groups, the RVFACU / TAPSE was lower and the ratio of MPI / E / A and E / E 'was higher in the group of bad collateral circulation before operation than that in the group of bad collateral circulation. It suggested that the systolic and diastolic function of right ventricle in the group with poor collateral circulation was lower than that in the group with good collateral circulation (P 0.05). There were 0 cases of severe arrhythmia in the good collateral circulation group and 8 cases in the bad collateral circulation group, accounting for 44.4% of the difference between the two groups (P 0.05), and there were 0 cases of serious arrhythmia in the good collateral circulation group after operation. There were 7 cases of bad collateral circulation group (38.9 cases). The difference was statistically significant. The average hospitalization days of the two groups were significantly higher than that of the control group (P 0.05). The length of stay in the group with bad collateral circulation was longer than that in the control group (P 0.05). Conclusion the right ventricular function decreased significantly in patients with RCA-CTO complicated with inferior myocardial infarction. The evaluation of right ventricular function by two dimensional echocardiography before operation can evaluate the difference between good and bad collateral circulation formation in these patients and has certain clinical significance.
【作者单位】：首都医科大学附属北京安贞医院超声心动图一部;首都医科大学基础医学院医学遗传学与发育生物学学系;
【基金】：北京自然科学基金(7141002)~~
【分类号】：R540.45;R542.22

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