应用实时三维超声心动图评价急性心梗患者二尖瓣构型的变化

发布时间：2018-04-08 23:39

本文选题：经胸超声心动图　切入点：实时三维　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:应用经胸实时三维超声心动图(RT 3D-TTE)研究急性心肌梗死(AMI)患者不同二尖瓣反流(MR)程度、不同梗死部位的二尖瓣构型变化,为AMI合并MR患者的治疗提供依据。方法:急性心梗患者89例,年龄39~76岁,平均(52±11)岁,急性心梗后72h内行超声心动图检查。根据彩色多普勒超声分为无反流组27例和反流组62例,反流组根据有效反流口面积(EROA)分为轻度MR组35例,中重度MR组27例;根据梗死部位不同,分为前壁病变组50例和下后壁病变组39例。正常对照组30例,年龄38-78岁,平均(52±17)岁。应用二维超声获得左室舒张末期内径(LVEDD)、收缩末期内径(LVESD),应用TomTec分析软件脱机分析获得左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左室射血分数(LVEF)和二尖瓣环参数。比较急性心梗无反流组、反流组、对照组间的常规超声心动图参数、二尖瓣环参数;比较急性心梗合并不同程度MR组间的常规超声心动图参数、二尖瓣环参数;比较不同梗死部位、合并不同程度MR组间的二尖瓣环参数;比较合并同等程度MR、不同梗死部位组间的常规超声心动图参数、二尖瓣环参数。结果:1.急性心梗无反流组与对照组比较,瓣环周长(AC)、非平面角度(NPA)增大;急性心梗合并反流组与对照组比较:反流组的瓣环前后直径(AP)、瓣环前外侧后内侧直径(AL-PM)、瓣环联合处直径(CD)、瓣环周长(AC)、瓣环二维面积(AA2D)、瓣环三维面积(AA3D)、幕状区容积(TV)、幕状区高度(TH)、非平面角度(NPA)均增大(p均0.05),瓣环高度(AH)、瓣环最大位移(ADMax)、最大位移速率(ADVMax)均减小(p均0.05)。2.不同程度MR组间比较,无反流组、轻度MR组、中重度MR组中AP、AC、CD、AA2D、AA3D、TV、TH逐渐增大,差异均有统计学意义(p均0.05);中重度MR组AL-PM大于轻度MR组(p0.05),AH、ADMax小于轻度MR组(p均0.05),轻度MR组与无反流组比较差异无统计学意义(p均0.05),ADVMax反流组组间比较差异无统计学意义(p0.05)。3.不同梗死部位,不同程度MR组间比较:中重度MR组AP、AL-PM、AC、CD、AA2D、AA3D、TV、TH大于轻度组,AH小于轻度MR组(p均0.05)。4.不同梗死部位合并同等程度MR组间比较,下后壁病变合并中重度MR组AA2D、AA3D大于前壁病变组,大于对照组(p均0.05),下后壁病变合并轻度MR组AP、AL-PM、AC、CD、AA2D、AA3D、TV、TH、AH、ADMax、ADVMax与前壁病变组差异无统计学意义(p均0.05)。结论:1.急性心梗无二尖瓣反流者,部分二尖瓣环结构发生变化;合并二尖瓣反流者,随着反流程度加重,二尖瓣环扩大越明显,马鞍形立体结构越趋于扁平,运动能力减弱。2.同等程度MR不同部位心梗者,下后壁心梗致二尖瓣环面积扩大更明显。3.实时经胸三维超声心动图可用来研究二尖瓣构型变化,为临床选择治疗方案提供一定的参考。
[Abstract]:Objective: to study the changes of mitral valve configuration in patients with acute myocardial infarction (AMI) with different degree of mitral regurgitation (MRV) and different infarct site by transthoracic real-time three-dimensional echocardiography (RT3D-TTER), and to provide evidence for the treatment of AMI with Mr.Methods: 89 patients with acute myocardial infarction aged 3976 years (mean 52 卤11) years were examined by echocardiography within 72 hours after acute myocardial infarction.According to color Doppler ultrasound, 27 cases were divided into no reflux group (n = 27) and reflux group (n = 62). Reflux group (n = 35) was divided into mild Mr group (n = 35) and moderate or severe Mr group (n = 27) according to effective reflux area.The patients were divided into anterior wall lesion group (n = 50) and inferior posterior wall lesion group (n = 39).30 cases of normal control group, age 38-78 years old, mean 52 卤17 years old.Left ventricular end-diastolic dimension (LVED) and end-systolic diameter (LVESD) were obtained by two-dimensional echocardiography. Left ventricular end-diastolic volume (LVEDVV), end-systolic volume (LVESVV), left ventricular ejection fraction (LVEF) and mitral annulus parameters were obtained by TomTec software off-line analysis.The parameters of conventional echocardiography, mitral annulus and mitral annulus in patients with acute myocardial infarction without reflux, reflux group and control group were compared, and the parameters of conventional echocardiography and mitral annulus in acute myocardial infarction with different degree of Mr were compared.The mitral annular parameters of different infarct sites and different degree of Mr were compared, and the conventional echocardiographic parameters and mitral annular parameters of different infarct locations were compared.The result is 1: 1.Compared with the control group, the annular circumference was increased in the acute myocardial infarction without reflux group.Comparison of acute myocardial infarction with regurgitation group: the anterior and posterior annular diameter of the regurgitation group was AL-PMN, the anterolateral posterior medial diameter of the annulus was AL-PMN, the diameter of the annular junction was CDI, the circumferential annular AAC, the 2-D area of the annular, the three-dimensional area of the annulus, the volume of the tentorial region.The height of TVB, the height of tabular area and the non-plane angle NPAs are all increased, the height of annular is 0.05g, the height of annular is AHHN, the maximum displacement of annulus is AHX, and the maximum displacement rate and the maximum rate of displacement are all decreased by 0.05n.2.Compared with Mr group of different degree, the th of ACA CDA2D AA-3D TV-TH increased gradually in no reflux group, mild Mr group, moderate and severe Mr group, and no reflux group, mild Mr group and moderate or severe Mr group.Comparison of different infarct sites and different degrees of Mr: APAL-PMMA ACU AL-PMN in moderate and severe Mr group was higher than that in mild Mr group (P < 0.05), and the ratio of AH in AH was higher than that in mild Mr group (P < 0.05).Conclusion 1.In patients with acute myocardial infarction without mitral regurgitation, some mitral annular structures changed, and in patients with mitral regurgitation, the enlargement of mitral annulus became more obvious, the saddle shape became flat, and the motor ability decreased with the increase of mitral regurgitation.The area of mitral annulus increased more significantly in patients with different MI in the same degree than that in inferior posterior wall myocardial infarction.Real-time three-dimensional echocardiography can be used to study mitral valve configuration and provide some reference for clinical treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R540.45

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