实时三维超声心动图对行急诊PCI的左心室室壁瘤患者短期疗效的评估

发布时间：2018-06-16 05:06

本文选题：实时三维超声心动图 + 左心室室壁瘤　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)对行急诊PCI的左心室室壁瘤(left ventricular aneurysm,LVA)患者的术前及术后2个月心功能的相关指标进行对比,评估急诊PCI的短期疗效。方法:应用RT-3DE收集31例急性前壁心肌梗死(acute myocardial infarction,AMI)并LVA患者术前、术后2月左心室的心功能参数,主要包括:左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、收缩末期容积(End-systolic volume,ESV)、心排血量(cardiac output,CO)、左心室射血分数(left ventricular ejection fraction,LVEF)及球形指数(spherical index,SPI),根据体表面积(body surface area,BSA(m2)=0.0061x身高(cm)+体重(kg)),计算出左室舒张末期容积指数(LVEDVI)、收缩末期容积指数(ESVI)、心脏指数(Cardiac index,CI)(LVEDVI=LVEDV/BSA,ESVI=ESV/BSA,CI=CO/BSA)。将研究对象分成功能性LVA(12例),解剖性LVA(11例),伴有血栓性LVA(8例)。对其术前、术后2月的心功能参数进行组内及组间比较;并对术前、术后2月的SPI、LVEF与相关心功能指标进行相关性分析。结果:(1)功能组术后2月的LVEF比术前增高,SPI降低,差异有统计学意义(P0.05)。(2)解剖组术前、术后2月的CO、CI、LVEF、SPI差异有统计学意义(P0.05),CO、CI、LVEF术后2月比术前高,SPI术后减低,其中SPI、LVEF显著性更高一些(P0.01)。(3)血栓组术后2月的SPI比术前有所下降,差异有统计学意义(P0.05);LVEF术后2月比术前有所提高(P0.05),差异无统计学意义。(4)三组组内相比:术后2月的LVEDV、ESV、EDVI、ESVI均比术前有所降低,但差异无统计学意义(P0.05)。(5)三组组间比较:术前及术后2月LVEF及SPI差异无统计学意义(P0.05)(6)(1)术前及术后2月的SPI与LVEF值呈负相关,与LVEDV、ESV、EDVI、ESVI、CO、CI呈正相关。(2)术前及术后2月的LVEF值与SPI、LVEDV、ESV、EDVI、ESVI、CO、CI呈负相关,其中LVEDV、ESV、EDVI、ESVI(P0.01)、CO、CI(P0.05)与LVEF值相关性有统计学意义。结论:(1)功能性和解剖性LVA患者PCI术后2月左心室形态及整体收缩功能改善,手术有效果;伴有血栓性LVA术后2月疗效不明显。(2)3RT-DE是评价急诊PCI对LVA患者的短期疗效的一种有效的方法,其中SPI及LVEF是重要的两个指标。
[Abstract]:Objective: to evaluate the short-term efficacy of three-dimensional in patients with left ventricular aneurysm (LVA) before and 2 months after emergency PCI by real-time three-dimensional echocardiography (RT3DE). Methods: the cardiac function parameters of left ventricle were collected from 31 patients with acute anterior wall myocardial infarction (AMI) and acute myocardial infarction (LVA) 2 months after operation by RT-3DE. These include left ventricular end-diastolic volume, end systolic volume, cardiac output, left ventricular ejection fraction and spherical index. According to body surface area, surface areaBSAm2X 0.0061x body height and body weight, the left ventricular ejection fraction (LVEF) and spherical index (SPII) are calculated according to the body surface area (surface areaan BSAm2P 0.0061x height / cm) and the left ventricular ejection fraction (LVEF) and the spherical index (SPII). The left ventricular ejection volume is calculated according to the body surface area (surface areaBSAm2X 0.0061x height / cm ~ (-1) and the left ventricular ejection fraction (LVEF) is calculated according to the body surface area (body surface area). End diastolic volume index (LVEDVI), end systolic volume index (ESVI), cardiac index (cardiac index), LVEDVI / BSAV / ESV/ BSAI / ESVP / BSAI / BSAA. The subjects were divided into 12 cases of functional LVAV, 11 cases of anatomic LVAV and 8 cases of thrombotic LVAV. The parameters of cardiac function before and after 2 months of operation were compared within and between groups, and the correlation between SPI LVEF and related cardiac function indexes was analyzed before and 2 months after operation. Results two months after operation, LVEF in functional group was significantly lower than that before operation. The difference was statistically significant (P 0.05). SPI of two months after operation was significantly lower in the dissection group than that in the control group (P < 0.05). The SPI of the two months after operation was significantly lower than that of the high SPI in the two months after operation, and the difference of SPI between two months after operation and two months after operation was significantly lower in the functional group than that in the preoperative high SPI. The SPIIV LVEF was significantly higher in the thrombus group than that in the preoperative group, and the SPI in the thrombus group was significantly lower at 2 months after operation than that in the preoperative group. There was a significant difference in LVEF between two months after operation and two months after operation. The difference was not statistically significant. There was no significant difference among the three groups: the EDVIESVI of LVEDVV ESVV / EDVIESVI was lower than that of preoperation 2 months after operation. But there was no significant difference among the three groups: there was no significant difference in LVEF and SPI between the three groups before and 2 months after operation. (P < 0.05) SPI was negatively correlated with LVEF before and 2 months after operation, but positively correlated with ESVICOCI before and after operation, and was negatively correlated with ESVI / ESVICOCI before and 2 months after operation, and there was a negative correlation between LVEF before and 2 months after operation and SPIVEDVE ESVI / ESVICOCI (P < 0. 05) before and 2 months after operation, there was a negative correlation between SPI and LVEF before and 2 months after operation, but there was a positive correlation between SPI and LVEF before and 2 months after operation. Among them, LVEDVV ESVI (ESVI) (P0.01) and LVEF (P0.05) were significantly correlated with LVEF. Conclusion the left ventricular morphology and global systolic function were improved 2 months after PCI in patients with functional and anatomical LVA. 2 months after operation with thrombotic LVA, 3RT-DE is an effective method to evaluate the short-term efficacy of emergency PCI in LVA patients. SPI and LVEF are two important indexes.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541;R540.45

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