组织运动二尖瓣环位移技术对急性前壁心肌梗死PCI术患者左心室收缩功能的评价
发布时间：2018-12-31 11:14
【摘要】：背景 急性心肌梗死(acute myocardial infarction,AMI)是一种严重威胁人们身体健康的疾病,其中以前壁心肌梗死较常见。急性心肌梗死患者往往病情严重,预后较差,急性心肌梗死临床上有多种治疗方法,冠状动脉介入(Percutaneous Coronary Intervention,PCI)作为一种内科有创性治疗急性心肌梗死的方法,具有安全系数高、创伤性小、治疗效果明显等特点,在临床上较广泛应用。但如何快速和准确地对PCI患者术后效果进行评估,具有非常重要意义,目前心脏超声技术是临床最常用于检测心室功能的技术,已得到临床医生的一致认可,具有无创、便宜、对病人要求低,准确性高等特点。尤其近年来各种新超声技术的广泛应用,使超声检查技术的准确性进一步提高,组织运动二尖瓣环位移测量(tracking of mitralanular displacement,TMAD)其在斑点追踪技术理论基础上进行心功能指标测量的新方法,TMAD技术通过斑点追踪技术测量二尖瓣瓣环相对于左心室心尖部心肌长轴运动,相对于传统M型超声具有较高时间分辨率,是对传统心功能检查方法缺点的弥补,对检测急性心急梗死患者心室功能早期改变具有重要意义。目的 评价二尖瓣环位移技术对急性前壁心肌梗死PCI术患者左心室收缩功能的诊断价值。材料与方法选择2013年6月-2014年6月在淮南市第一人民医院心血管内科接受PCI手术的急性前壁心肌梗死患者作为研究组,另选取32例有相同合并症及用药史的冠心病患者作为对照组,使用飞利浦IE33彩色超声诊断仪器,分别术前1周内、术后2个月均采用Simpson方法测定左心室射血分数(LVEF).另选取心尖四腔心、两腔心及左室长轴两腔心,应用机器自带软件Qlab6.0软件进行组织运动二尖瓣瓣环位移测量(TMAD)及二尖瓣环的收缩期平均位移峰值(Ds)测量,并进行数据分析研究。运用SPSS16.0统计软件分析PCI手术前后AMI患者的TMAD及Ds数据,来评估左心室收缩功能的变化,同时应用Person直线相关性来检验TMAD及Ds数据与LVEF的相关性,并绘制散点图。结果1.AMI手术后组LVEF较AIM手术后组结果有所提高,但p0.05,差异不具有统计学意义,AMI手术后组LVESV较AMI手术前组有所改善,p0.05差异具有统计学意义。2.AMI手术前组、手术后组TMAD参数比较,AMI手术后组TMAD参数较手术前明显升高,尤其TMADmidpt%较为明显,p0.01,差异具有显著统计学意义。3.AMI手术后组Ds与AMI手术前组Ds数据比较明显提高,p0.05,差异具有统计学意义；AMI手术前组Ds参数较对照组二尖瓣环Ds明显减低,p0.01,差异具有明显统计学的意义。4.AMI手术前、手术后组TMAD参数与LVEF均存在显著的正相关性,AMI手术前、后组二尖瓣环6个位点平均Ds与LVEF亦呈正相关性(p均为0.000)。结论TMAD技术评价急性前壁心急梗死PCI术患者左心室收缩功能的早期改变较辛普森法测定的左室射血分数更敏感。
[Abstract]:Background Acute Myocardial Infarction (acute myocardial infarction,AMI) is a serious threat to people's health. Patients with acute myocardial infarction often have a serious condition and poor prognosis. There are many kinds of treatment methods in acute myocardial infarction. Coronary intervention (Percutaneous Coronary Intervention,PCI) is a kind of internal invasive treatment for acute myocardial infarction. It is widely used in clinic because of its high safety factor, small trauma and obvious therapeutic effect. However, it is of great significance to evaluate the postoperative results of PCI patients quickly and accurately. At present, echocardiography is the most commonly used technique to detect ventricular function in clinic, which has been unanimously recognized by clinicians, and is noninvasive and inexpensive. Low demand for patients, high accuracy and other characteristics. Especially in recent years, with the wide application of various new ultrasound techniques, the accuracy of ultrasonic examination technique has been further improved. Tissue motion mitral annulus displacement measurement (tracking of mitralanular displacement, TMAD) is a new method to measure cardiac function index based on dot-tracing technique. TMAD technique is used to measure mitral annular movement relative to left ventricular apical myocardial long axis. Compared with the traditional M-mode ultrasound, it has higher time resolution, which is a remedy for the shortcomings of the traditional cardiac function examination method, and it is of great significance to detect the early changes of ventricular function in patients with acute myocardial infarction. Objective to evaluate the value of mitral annular displacement in the diagnosis of left ventricular systolic function in PCI patients with acute anterior myocardial infarction. Materials and methods patients with acute anterior myocardial infarction underwent PCI operation in Department of Cardiovascular Medicine, first people's Hospital of Huainan City from June 2013 to June 2014, were selected as the study group. Another 32 patients with coronary heart disease with the same complication and history of medication were selected as control group. The left ventricular ejection fraction (LVEF).) was measured by Simpson method within 1 week before operation and 2 months after operation using Philips IE33 color ultrasound diagnostic apparatus. In addition, the apical four-chamber heart, two-chamber heart and left ventricular long-axis two-chamber heart were selected to measure the mitral annular displacement by using the software Qlab6.0 software. The mitral annular displacement was measured by (TMAD) and (Ds). And carries on the data analysis research. The TMAD and Ds data of AMI patients before and after PCI operation were analyzed by SPSS16.0 software to evaluate the changes of left ventricular systolic function. The correlation between TMAD and Ds data and LVEF was examined by Person linear correlation. Results the results of LVEF in 1.AMI group were higher than those in AIM group, but the difference was not statistically significant (p 0.05). The LVESV of AMI group was better than that of AMI group after AMI operation, and the difference was statistically significant before 2.AMI operation. The TMAD parameters of AMI group were significantly higher than those of pre-operation group, especially TMADmidpt%, p0.01, the difference was statistically significant. The Ds data of 3.AMI group and AMI group were significantly higher than that of AMI group. P0.05, the difference was statistically significant. The Ds of mitral annulus in AMI group was significantly lower than that in control group (p 0.01). Before and after 4.AMI operation, there was a significant positive correlation between TMAD parameters and LVEF, and before AMI operation, there was a significant positive correlation between TMAD parameters and LVEF. There was also a positive correlation between the mean Ds and LVEF at 6 sites of mitral annulus in the posterior group (p = 0.000). Conclusion TMAD is more sensitive than Simpson method in evaluating the early changes of left ventricular systolic function in patients with acute anterior wall acute infarction (PCI).
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
本文编号：2396491
[Abstract]:Background Acute Myocardial Infarction (acute myocardial infarction,AMI) is a serious threat to people's health. Patients with acute myocardial infarction often have a serious condition and poor prognosis. There are many kinds of treatment methods in acute myocardial infarction. Coronary intervention (Percutaneous Coronary Intervention,PCI) is a kind of internal invasive treatment for acute myocardial infarction. It is widely used in clinic because of its high safety factor, small trauma and obvious therapeutic effect. However, it is of great significance to evaluate the postoperative results of PCI patients quickly and accurately. At present, echocardiography is the most commonly used technique to detect ventricular function in clinic, which has been unanimously recognized by clinicians, and is noninvasive and inexpensive. Low demand for patients, high accuracy and other characteristics. Especially in recent years, with the wide application of various new ultrasound techniques, the accuracy of ultrasonic examination technique has been further improved. Tissue motion mitral annulus displacement measurement (tracking of mitralanular displacement, TMAD) is a new method to measure cardiac function index based on dot-tracing technique. TMAD technique is used to measure mitral annular movement relative to left ventricular apical myocardial long axis. Compared with the traditional M-mode ultrasound, it has higher time resolution, which is a remedy for the shortcomings of the traditional cardiac function examination method, and it is of great significance to detect the early changes of ventricular function in patients with acute myocardial infarction. Objective to evaluate the value of mitral annular displacement in the diagnosis of left ventricular systolic function in PCI patients with acute anterior myocardial infarction. Materials and methods patients with acute anterior myocardial infarction underwent PCI operation in Department of Cardiovascular Medicine, first people's Hospital of Huainan City from June 2013 to June 2014, were selected as the study group. Another 32 patients with coronary heart disease with the same complication and history of medication were selected as control group. The left ventricular ejection fraction (LVEF).) was measured by Simpson method within 1 week before operation and 2 months after operation using Philips IE33 color ultrasound diagnostic apparatus. In addition, the apical four-chamber heart, two-chamber heart and left ventricular long-axis two-chamber heart were selected to measure the mitral annular displacement by using the software Qlab6.0 software. The mitral annular displacement was measured by (TMAD) and (Ds). And carries on the data analysis research. The TMAD and Ds data of AMI patients before and after PCI operation were analyzed by SPSS16.0 software to evaluate the changes of left ventricular systolic function. The correlation between TMAD and Ds data and LVEF was examined by Person linear correlation. Results the results of LVEF in 1.AMI group were higher than those in AIM group, but the difference was not statistically significant (p 0.05). The LVESV of AMI group was better than that of AMI group after AMI operation, and the difference was statistically significant before 2.AMI operation. The TMAD parameters of AMI group were significantly higher than those of pre-operation group, especially TMADmidpt%, p0.01, the difference was statistically significant. The Ds data of 3.AMI group and AMI group were significantly higher than that of AMI group. P0.05, the difference was statistically significant. The Ds of mitral annulus in AMI group was significantly lower than that in control group (p 0.01). Before and after 4.AMI operation, there was a significant positive correlation between TMAD parameters and LVEF, and before AMI operation, there was a significant positive correlation between TMAD parameters and LVEF. There was also a positive correlation between the mean Ds and LVEF at 6 sites of mitral annulus in the posterior group (p = 0.000). Conclusion TMAD is more sensitive than Simpson method in evaluating the early changes of left ventricular systolic function in patients with acute anterior wall acute infarction (PCI).
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
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