心肌致密化不全45例临床分析
发布时间：2018-12-17 21:10
【摘要】：目的:探讨心肌致密化不全(Noncompaction of Ventricular Myocardium,NVM)患者的临床特点及超声心动图诊断特点,提高临床医生对心肌致密化不全患者的认识和临床诊疗水平,减少临床误诊及漏诊,早期发现、早期干预。方法:收集济宁医学院附属医院自2103年1月至2014年12月超声心动图符合心肌致密化不全诊断标准的45例住院患者病历资料进行回顾性分析,对心肌致密化不全患者的临床特点及影像学特点进行总结,选取同期45例超声心动图正常结果者作为对照组,与NVM患者超声心动图左心室收缩功能指标进行分析比较,复习相关文献展开讨论。结果:本研究中患者共45例,男20例,女25例,年龄8-73岁,平均58±15岁,男性占44.44%。心肌致密化不全患者以心力衰竭、心律失常及血栓栓塞为主要临床表现,45例患者表现为程度不等的心力衰竭,31例患者有心悸不适,1例有脑梗塞,1例患者有短暂脑缺血发作,1例患者因急性心肌梗死入院行心脏彩超检查发现心肌致密化不全。40例患者胸片检查,33例患者有不同程度心脏扩大。所有患者均接受常规心电图检查,全部显示出异常,其中有32例患者为ST-T改变,21例表现为室内传导阻滞,18例患者有室性心律失常,21例患者做24小时动态心电图检查提示频发室性早搏、室性早搏二联律、短阵室性心动过速。所有患者均通过超声心动图检查,达到心肌致密化不全超声心动图诊断标准,所有患者均见粗大的肌小梁及深陷的隐窝,形成网状结构,隐窝间暗淡缓慢血流与心腔相通,病变心室壁分为2层,其中成人非致密化心肌与致密化心肌比值介于2.0-3.6之间,平均侧壁为2.28±0.62,后壁2.33±0.73。有27例患者左室射血分数小于30%,占60%,13例患者左室射血分数处于30%-50%之间,占28.89%,5例射血分数大于50%,占11.11%,其中合并二尖瓣返流43例,三尖瓣返流26例,心包积液16例,与正常对照组比较,年龄平均值接近,P=0.078,差异无统计学意义;反映左心室收缩功能的指标包括左室舒张末期内径、左室射血分数等进行比较,P均小于0.01,差异有显著统计学意义。其中作心脏磁共振(CMR)和心脏CT平扫加增强检查的患者各1例,均符合NVM特征性改变。结论:心肌致密化不全临床上少见,发病率低,以进行性加重的心力衰竭、多系统栓塞事件、各种心律失常为主要临床表现。超声心动图是最主要的检查方法及确诊手段,但在技术水平上有待进一步探索提高,心脏磁共振检查、心脏CT增强扫描在一定程度上对其起补充作用。药物治疗可以一定程度上改善患者症状。
[Abstract]:Objective: to investigate the clinical characteristics and echocardiographic diagnosis of myocardial compaction insufficiency (Noncompaction of Ventricular Myocardium,NVM) in order to improve the understanding and clinical diagnosis of the patients with myocardial compactness, and to reduce the misdiagnosis and missed diagnosis. Early detection, early intervention. Methods: the medical records of 45 inpatients who met the diagnostic criteria of myocardial compactness by echocardiography from January 2103 to December 2014 in affiliated Hospital of Jining Medical College were retrospectively analyzed. The clinical and imaging features of patients with myocardial compaction insufficiency were summarized. 45 patients with normal echocardiographic results were selected as control group and compared with patients with NVM on left ventricular systolic function. Review the relevant literature for discussion. Results: in this study, there were 45 patients (20 males and 25 females), aged 8-73 years (mean 58 卤15 years). Heart failure, arrhythmia and thromboembolism were the main clinical manifestations in patients with myocardial compactness, 45 patients showed heart failure of varying degrees, 31 patients had palpitation and discomfort, and 1 patient had cerebral infarction. One patient had transient ischemic attack, one patient had myocardial compactness by color Doppler echocardiography, and 33 patients had heart dilatation in varying degrees. The results were as follows: 1 patient had transient ischemic attack, 1 patient had myocardial insufficiency by color Doppler echocardiography, 40 patients had chest radiography, and 33 patients had heart enlargement in varying degrees. All the patients were examined by routine electrocardiogram, all of them showed abnormal changes, including 32 patients with ST-T changes, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia. The 24-hour ambulatory electrocardiogram examination of 21 patients showed frequent ventricular premature beat, ventricular premature beat biphasic, short ventricular tachycardia. All the patients achieved the diagnostic criteria of myocardial densification insufficiency by echocardiography. All the patients showed thick trabeculae and deep recess, forming a reticular structure, and the dim blood flow between recesses communicating with the heart cavity. The ratio of nondensified myocardium to densified myocardium was between 2.0-3.6, the average lateral wall was 2.28 卤0.62, and the posterior wall was 2.33 卤0.73. The left ventricular ejection fraction (LVEF) was less than 30% in 27 patients, and the left ventricular ejection fraction was between 30% and 50% in 13 patients. The left ventricular ejection fraction (LVEF) was between 30% and 50% in 13 patients, and the ejection fraction was greater than 50 in 5 cases (11.11%) in which 43 cases were complicated with mitral regurgitation. There were 26 cases of tricuspid regurgitation and 16 cases of pericardial effusion. The indexes reflecting left ventricular systolic function included left ventricular end-diastolic diameter and left ventricular ejection fraction (P < 0.01). One case of cardiac magnetic resonance (CMR) and one case of cardiac CT were examined by plain scan and enhanced enhancement, all of them were in accordance with the characteristic changes of NVM. Conclusion: myocardial compaction insufficiency is rare in clinic and its incidence is low. The main clinical manifestations are heart failure with progressive exacerbation, multiple systemic embolism events and various arrhythmias. Echocardiography is the most important examination method and diagnostic method, but it needs to be further explored and improved on the technical level. Cardiac magnetic resonance examination and cardiac CT enhanced scan play a supplementary role to some extent. Drug therapy can improve the symptoms of patients to some extent.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.2
本文编号：2384802
[Abstract]:Objective: to investigate the clinical characteristics and echocardiographic diagnosis of myocardial compaction insufficiency (Noncompaction of Ventricular Myocardium,NVM) in order to improve the understanding and clinical diagnosis of the patients with myocardial compactness, and to reduce the misdiagnosis and missed diagnosis. Early detection, early intervention. Methods: the medical records of 45 inpatients who met the diagnostic criteria of myocardial compactness by echocardiography from January 2103 to December 2014 in affiliated Hospital of Jining Medical College were retrospectively analyzed. The clinical and imaging features of patients with myocardial compaction insufficiency were summarized. 45 patients with normal echocardiographic results were selected as control group and compared with patients with NVM on left ventricular systolic function. Review the relevant literature for discussion. Results: in this study, there were 45 patients (20 males and 25 females), aged 8-73 years (mean 58 卤15 years). Heart failure, arrhythmia and thromboembolism were the main clinical manifestations in patients with myocardial compactness, 45 patients showed heart failure of varying degrees, 31 patients had palpitation and discomfort, and 1 patient had cerebral infarction. One patient had transient ischemic attack, one patient had myocardial compactness by color Doppler echocardiography, and 33 patients had heart dilatation in varying degrees. The results were as follows: 1 patient had transient ischemic attack, 1 patient had myocardial insufficiency by color Doppler echocardiography, 40 patients had chest radiography, and 33 patients had heart enlargement in varying degrees. All the patients were examined by routine electrocardiogram, all of them showed abnormal changes, including 32 patients with ST-T changes, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia. The 24-hour ambulatory electrocardiogram examination of 21 patients showed frequent ventricular premature beat, ventricular premature beat biphasic, short ventricular tachycardia. All the patients achieved the diagnostic criteria of myocardial densification insufficiency by echocardiography. All the patients showed thick trabeculae and deep recess, forming a reticular structure, and the dim blood flow between recesses communicating with the heart cavity. The ratio of nondensified myocardium to densified myocardium was between 2.0-3.6, the average lateral wall was 2.28 卤0.62, and the posterior wall was 2.33 卤0.73. The left ventricular ejection fraction (LVEF) was less than 30% in 27 patients, and the left ventricular ejection fraction was between 30% and 50% in 13 patients. The left ventricular ejection fraction (LVEF) was between 30% and 50% in 13 patients, and the ejection fraction was greater than 50 in 5 cases (11.11%) in which 43 cases were complicated with mitral regurgitation. There were 26 cases of tricuspid regurgitation and 16 cases of pericardial effusion. The indexes reflecting left ventricular systolic function included left ventricular end-diastolic diameter and left ventricular ejection fraction (P < 0.01). One case of cardiac magnetic resonance (CMR) and one case of cardiac CT were examined by plain scan and enhanced enhancement, all of them were in accordance with the characteristic changes of NVM. Conclusion: myocardial compaction insufficiency is rare in clinic and its incidence is low. The main clinical manifestations are heart failure with progressive exacerbation, multiple systemic embolism events and various arrhythmias. Echocardiography is the most important examination method and diagnostic method, but it needs to be further explored and improved on the technical level. Cardiac magnetic resonance examination and cardiac CT enhanced scan play a supplementary role to some extent. Drug therapy can improve the symptoms of patients to some extent.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.2
【参考文献】
相关期刊论文 前1条
1 刘江泽;殷红霞;陈海燕;罗丽;李华贵;;实时三维超声心动图对心肌致密化不全的诊断价值[J];临床超声医学杂志;2011年06期
，本文编号：2384802
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