四维超声心动图评价急性心肌梗死急诊PCI术后左心室功能改变的研究

发布时间：2018-06-13 23:21

本文选题：急性心肌梗死 + 左心室功能　；参考：《山西医科大学》2017年硕士论文

【摘要】：背景冠心病(CHD)是指在冠状动脉的动脉粥样硬化病变,动脉粥样硬化的不断发展会阻碍血液流动,造成局部慢性或急性缺血,冠状动脉的粥样硬化斑块的形成是一个长期的过程,往往在早期即开始形成,当血管受堵达到一定程度时则出现相应的临床表现。粥样斑块可导致患者在运动、紧张或静息状态下的心绞痛症状、斑块破裂导致急性血栓形成、猝死以及急性心肌梗死。在美国,超过1700万人患有冠心病,近10万人有心绞痛症状,至少有380000人因心肌梗死或与冠心病相关其他疾病猝死[1]。在我国,急性心肌梗死(AMI)已成为严重威胁生命健康的疾病之一[2]。急性心肌梗死血流重建的方式主要有三种,分别为:药物溶栓治疗、介入PCI术以及冠状动脉旁路移植术。PCI术作为再灌注治疗有效手段之一,能直接开通梗死相关动脉,恢复缺血心肌的血液供应,可以有效限制和缩小梗死面积,保护左心室的功能,改善病人的心室重构和近期预后[3]。UCG在急性心肌梗死方面有极高预测价值,同时也可作为判断PCI术后心脏功能改变的一个重要依据[4],从而广泛应用于AMI病人行PCI术后左室功能的评价。目的本课题通过对首发AMI患者行急诊PCI术,对患者术前、术后7天、2月分别进行二维、四维超声检查,探讨四维超声心动图评价AMI患者行急诊PCI术后左室心功能改变的价值。方法选取2016年4月至10月收治入院的初发急性心肌梗死、并符合实验要求的50名患者入选病例组。排除既往有心肌梗死、心功能不全、恶性心律失常、糖尿病、肾功能衰竭等病史以及肥胖的患者。对入选病例组患者术前行二维、四维超声心动图检查,并记录2D-LVEDV、2D-LVESV、2D-LVEF、4D-LVEDV、4D-LVESV、4D-LVEF、GLS、GCS、GAS、GRS,为术前组;同一患者术后7天、2月均行二维、四维超声心动图检查,记录实验数据,分别为术后7天、2个月组;急诊PCI术后7天组,2个月组参数与术前组参数进行统计学分析,4D-LVEF与心室应变参数进行相关性分析。结果(1)术后7天与术前相比,2D-LVEDV2D-LVESV及2D-LVEF的变化均无统计学意义(p0.05);术后2月与术后7天相比,2D-LVEDV及2D-LVEF的变化均无统计学意义(p0.05),2D-LVESV差异有统计学意义(p0.05);术后2月与术前相比,2D-LVEDV的变化无统计学意义(p0.05),2D-LVESV及2D-LVEF差异有统计学意义(p0.05)。(2)术后7天与术前相比,4D-LVEDV的变化无统计学意义(p0.05),4D-LVESV及4D-LVEF差异有统计学意义(p0.05);术后2月与术后7天相比,4D-LVEF的变化无统计学意义(p0.05),4D-LVEDV及4D-LVESV差异有统计学意义(p0.05);术后2月与术前相比,4D-LVEDV、4D-LVESV及4D-LVEF差异均有统计学意义(p0.05)。(3)术前即刻组、术后7天组与术后2月组相比,GLS、GCS、GRS及GAS数值均增大,只有GAS术后2月与术前差异有统计学意义(p0.05)。结论1.急性心肌梗死患者在行急诊PCI术后,左心室功能较术前得到显著改善。2.四维超声心动图在评价急性心肌梗死行急诊PCI术术后左心室功能评价上有重要价值,且比二维超声心动图更早期、敏感、准确的检测出术后左室形态和功能的变化。3.临床上,四维左心室整体射血分数及心肌应变能定量评价急性心肌梗死患者急诊PCI术术前及术后的左心室功能,心肌应变参数能全面、准确、敏感地定量评价室壁心肌运动的早期变化,其中四维应变中整体面积应变(GAS)在判断左室心肌运动减弱最敏感。
[Abstract]:Background coronary artery disease (CHD) refers to atherosclerotic lesions in the coronary arteries. The continuous development of atherosclerosis will impede blood flow and cause local chronic or acute ischemia. The formation of atherosclerotic plaque in coronary arteries is a long-term process, often in the early stages, when the blood vessel is blocked to a certain extent. Atherosclerotic plaque can lead to angina, acute thrombosis, sudden death, and acute myocardial infarction. In the United States, more than 17 million people suffer from coronary heart disease, nearly 100 thousand have angina, and at least 380000 are associated with myocardial infarction or coronary heart disease. Sudden death of other diseases ([1].) in China, acute myocardial infarction (AMI) has become one of the serious threats to life and health. There are three main ways of blood flow reconstruction in acute myocardial infarction: thrombolytic therapy, interventional PCI, and coronary artery bypass grafting (.PCI) as one of the effective means of reperfusion therapy, which can be directly opened. The infarct related artery and the recovery of the blood supply of the ischemic myocardium can effectively restrict and reduce the infarct size, protect the function of the left ventricle, improve the ventricular remodeling and the short-term prognosis of the patients with [3].UCG in the acute myocardial infarction, and can also be used as an important basis for judging the changes of cardiac function after PCI, thus, [4] The purpose of this study was to evaluate the left ventricular function of AMI patients after PCI. The purpose of this study was to evaluate the value of the left ventricular function change after the emergency PCI operation in the first AMI patients before the emergency PCI operation, and to evaluate the value of the left ventricular function after the emergency PCI operation in the first AMI patients. The value of the four dimensional echocardiography was evaluated before the operation and 7 days after the operation. In October, 50 patients with primary acute myocardial infarction were admitted to the hospital, which met the requirements of the experimental group. They excluded the history of myocardial infarction, cardiac insufficiency, malignant arrhythmia, diabetes, renal failure, and obese patients. Two dimensional, four dimensional echocardiography was performed before the operation of the selected case group, and the 2D-LVED was recorded. V, 2D-LVESV, 2D-LVEF, 4D-LVEDV, 4D-LVESV, 4D-LVEF, GLS, GCS, GAS, GRS, for the same patient 7 days after operation, 7 days, four dimensional echocardiography examination, record experimental data, 7 days after operation, 2 months group, 7 days after emergency PCI operation, 2 months group parameters and preoperative group parameters of statistical analysis, 4D-LVEF and ventricular strain parameters Results (1) the changes in 2D-LVEDV2D-LVESV and 2D-LVEF were not statistically significant (P0.05) at 7 days after operation, and there was no statistical significance (P0.05) in the changes of 2D-LVEDV and 2D-LVEF in February and 7 days after the operation, and the difference in 2D-LVESV was statistically significant (P0.05). The changes of 2D-LVEDV were not statistically significant in February after operation. The difference between 2D-LVESV and 2D-LVEF was statistically significant (P0.05). (2) there was no statistical significance (P0.05) in the changes of 4D-LVEDV (P0.05), and the difference between 4D-LVESV and 4D-LVEF (P0.05). There was no statistical significance (P0.05) in the changes of 4D-LVEF in February and 7 days after the operation (P0.05). There was a statistical difference between 4D-LVEDV and 4D-LVEF. Significance (P0.05); the difference in 4D-LVEDV, 4D-LVESV and 4D-LVEF in February after operation was statistically significant (P0.05). (3) the number of GLS, GCS, GRS and GAS increased in the immediate group before operation and in the 7 days after operation, compared with those in the group after the operation, only the difference between February and preoperative was statistically significant (P0.05). Conclusion 1. acute myocardial infarction patients were in emergency PCI. After operation, the left ventricular function was significantly improved by.2. four dimensional echocardiography in evaluating left ventricular function after emergency PCI operation in acute myocardial infarction, and the changes of left ventricular form and energy after operation were more early, sensitive and accurate than that of two dimensional echocardiography..3. The scores and myocardial strain energy can be used to evaluate the left ventricular function before and after the emergency PCI operation in acute myocardial infarction patients. The myocardial strain parameters can be used to evaluate the early changes of ventricular wall motion in a comprehensive, accurate and sensitive way, in which the overall area strain (GAS) in the four dimensional strain is the most sensitive to the left ventricular myocardial movement.
【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

【参考文献】