单心动周期三维超声评价冠心病患者PCI术前后左心室功能及同步性研究

发布时间：2019-06-18 17:08

【摘要】：目的：探讨单心动周期实时三维超声心动图（sRT-3DE）评价冠状动脉左前降支（LAD）病变的急性心肌梗死（AMI）和慢性稳定性冠心病患者经皮冠状动脉介入治疗（PCI）后左心室功能及同步性参数的早期变化情况，以及左心室功能及同步性指标与狭窄程度之间的相关性，为PCI提供了术前评价及术后近期疗效的评估。方法：选择LAD行PCI的AMI患者（39例）及慢性稳定性冠心病患者（48例），于术前及术后1周分别行sRT-3DE检查，，获得以下左室功能及同步性参数，左心室功能性参数：射血分数（EF）、心缩末期容积（ESV）、心舒末期容积（EDV）、心搏量（SV）、心缩末期球形指数（ESSI）、心舒末期球形指数（EDSI），左心室收缩同步性参数：16节段心缩非同步指数（SDI16）、16节段心缩末期离散度（DISPES16）、16节段心缩末期平均时间（MES16）、16节段收缩前时间与容积（Pre Contr16）、16节段收缩后时间与容积（Post Contr16），左心室舒张同步性参数：16节段心舒非同步指数（DDI16）、16节段心舒末期离散度（DISPED16）、16节段心舒末期平均时间（MED16）、16节段舒张前时间与容积（Pre Relax16）、16节段舒张后时间与容积（Post Relax16）。对于以上参数，根据改良Gensini评分将AMI组及慢性稳定性冠心病组均再分为轻、中、重度三组，同组研究对象比较术前、术后参数的差异，全部研究对象的16个术前指标分别与狭窄程度进行相关性研究。采用SPSS17.0统计学软件进行统计分析，患者术前、术后比较采用配对t检验，以P＜0.05为差异有统计学意义；相关分析采用Spearman相关，检验水平均为α=0.05，以P＜0.05有相关性。结果：AMI的轻、中、重度组均术后1周EF、SV高于术前（P＜0.05），ESV、EDV、 ESSI、 EDSI、 SDI、 DISPES、 MES、 Pre Contr、 Post Contr、 DDI、DISPED、MED、Pre Relax、Post Relax低于术前（P＜0.05）；慢性稳定性冠心病轻、中度组术后1周EF、SV、ESV、EDV、ESSI、EDSI、SDI、DISPES、MES、PreContr、Post Contr、DDI、DISPED、MED、Pre Relax、Post Relax与术前相比无统计学意义（P＞0.05），慢性稳定性冠心病重度组术后1周EF、SV高于术前（P＜0.05），ESV、EDV、ESSI、EDSI、SDI、DISPES、MES、Pre Contr、Post Contr、DDI、DISPED、MED、Pre Relax、Post Relax低于术前（P＜0.05）；左室功能及同步性与狭窄程度无相关性（P＞0.05）。结论：AMI患者PCI术后1周左室功能和同步性较术前改善；改良Gensini评分相对较低的轻中度慢性稳定型冠心病患者PCI术后1周左室功能及同步性较术前无明显变化，改良Gensini评分相对较高的重度慢性稳定性冠心病患者术后1周左室功能及同步性较术前有所改善。
[Abstract]:Objective: to investigate the early changes of left ventricular function and synchronization parameters in patients with acute myocardial infarction (AMI) with left anterior descending coronary artery disease (LAD) and patients with chronic stable coronary heart disease (LAD) after percutaneous coronary intervention (PCI), and the correlation between left ventricular function and synchronization and the degree of stenosis. It provides the preoperative evaluation and the evaluation of the short-term curative effect after operation for PCI. Methods: 39 patients with AMI and 48 patients with chronic stable coronary heart disease underwent PCI with LAD. SRT-3DE was performed before and 1 week after operation. The following left ventricular function parameters and left ventricular functional parameters were obtained: ejection fraction (EF), end systolic volume (ESV), diastolic end volume (EDV), systolic end volume (SV), cardiac systolic end spherical index (EDSI),. Left ventricular systolic synchronization parameters: 16 segment systolic asynchronous index (SDI16), 16 segment end systolic dispersion (DISPES16), 16 segment end systolic mean time (MES16), 16 segment presystolic time and volume (Pre Contr16), 16 segment post systolic time and volume (Post Contr16), left ventricular diastolic synchronization index (DDI16), 16 segment end diastolic dispersion (DISPED16), The mean diastolic time (MED16), prediastolic time and volume (Pre Relax16) and postdiastolic time and volume (Post Relax16) of 16 segments were compared with those of 16 segments. According to the modified Gensini score, the AMI group and the chronic stable coronary heart disease group were divided into three groups: mild, moderate and severe. The differences of preoperative and postoperative parameters were compared in the same group. The 16 preoperative indexes of all the subjects were correlated with the degree of stenosis, respectively. The statistical analysis was carried out by SPSS17.0 statistical software. Pairing t test was used to compare the patients before and after operation, the difference was statistically significant (P < 0.05), and the correlation analysis was carried out by Spearman, the test level was 伪 = 0.05, P < 0.05. Results: EF,SV and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax in mild, moderate and severe AMI groups were higher than those before operation one week after operation (P < 0.05), and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax were lower than those before operation (P < 0.05). There was no significant difference in EF,SV,ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax,Post Relax at 1 week after operation in mild and moderate chronic stable coronary heart disease group compared with that before operation. EF,SV in severe chronic stable coronary heart disease group was higher than that before operation (P < 0.05), and ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax, was higher in severe chronic stable coronary heart disease group one week after operation (P < 0.05). Post Relax was lower than that before operation (P < 0.05). There was no correlation between left ventricular function and synchronization and the degree of stenosis (P > 0.05). Conclusion: the left ventricular function and synchronization of AMI patients with PCI were improved 1 week after operation, the left ventricular function and synchronization of patients with mild to moderate chronic stable coronary heart disease with relatively low Gensini score were not significantly different from those before operation, but the left ventricular function and synchronization of patients with severe chronic stable coronary heart disease with higher modified Gensini score were improved one week after operation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.4;R540.45

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