急诊经皮冠状动脉介入术后心肌灌注对心肌收缩功能恢复的预测价值

发布时间：2018-06-01 22:27

本文选题：心肌梗死 + 急性病　；参考：《中国医学影像学杂志》2017年05期

【摘要】：目的探讨急诊经皮冠状动脉介入术(PPCI)后心肌微循环灌注水平对心肌收缩功能恢复程度的预测价值,以早期发现心肌无复流,改善患者不良预后。资料与方法选取49例接受PPCI治疗的急性心肌梗死(AMI)患者为研究对象,术后1周内行二维应变成像(2DS)、静息定性心肌声学造影(MCE)检查,术后3个月复查2DS。应用2DS测量各节段心肌收缩期纵向峰值应变(LPSS),并根据LPSS牛眼图彩色编码将左心室心肌分为收缩功能正常(红色)、收缩功能受损(浅红色、蓝色)心肌。应用MCE目测半定量法对各节段心肌进行灌注评分(MPS),并根据MPS将收缩功能受损心肌分为灌注良好、灌注减少、灌注缺失心肌。比较各灌注水平间△LPSS(3个月各节段心肌LPSS与术后1周的差值),同时将MPS分别与术后1周、术后3个月LPSS行相关性分析。结果△LPSS的组间比较为灌注良好心肌灌注减少心肌灌注缺失心肌[(-5.78±6.23)%比(-4.37±6.60)%比(-1.21±4.77)%,P0.05];PPCI术后1周心肌MPS与术后1周、术后3个月LPSS均呈正相关(r=0.47、0.58,P0.001);2名评估者对心肌灌注评分一致性较好(Kappa=0.785,P0.05)。结论 AMI患者PPCI术后心肌灌注水平与心肌收缩功能相关,可预测心肌收缩功能恢复程度。
[Abstract]:Objective to explore the predictive value of myocardial microcirculation perfusion level after percutaneous coronary intervention (PPCI) on the degree of myocardial contractile function recovery, in order to find no reflow of myocardium early and improve the poor prognosis of the patients. Data and methods selected 49 patients with acute myocardial infarction (AMI) treated with PPCI as the research object and two dimensional two weeks after operation. Strain imaging (2DS), resting qualitative myocardial contrast echocardiography (MCE) examination, 3 months after operation, 2DS. application 2DS measured the longitudinal peak systolic peak strain (LPSS) of each segment of the myocardium, and divided the left ventricular myocardium into normal systolic function (red), contractile function (light red, blue) myocardium based on the color coding of LPSS bull's eye. Semi quantitative MCE visual measurement was used. Myocardial perfusion score (MPS) was performed on each segment of the myocardium, and the systolic function damaged myocardium was divided into good perfusion, decreased perfusion and perfusion missing myocardium, and the difference between LPSS and 1 weeks after the operation was compared between the 3 months of perfusion level and the correlation between MPS and 1 weeks after the operation and 3 months after the operation was analyzed. The result was Delta LPSS. The myocardial perfusion of good perfusion was compared with that of myocardial perfusion loss (-5.78 + 6.60)% ratio (-4.37 + 6.60)% (-1.21 + 4.77)% (-1.21 + 4.77)%, P0.05]. 1 weeks after PPCI, myocardial MPS was positively correlated with LPSS after operation (r=0.47,0.58, P0.001) 3 months after operation (r=0.47,0.58, P0.001); 2 assessors had better consistency of myocardial perfusion score (Kappa=0.785, P0.05). Conclusion AMI The level of myocardial perfusion after PPCI is related to myocardial contractility, and it can predict the degree of myocardial systolic function recovery.
【作者单位】：中山大学附属佛山市第一人民医院超声诊疗中心;
【基金】：广东省科技计划项目(2013B021800034)
【分类号】：R540.45;R542.22

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