【作者】 王小娟；

【导师】 张钲；

【作者基本信息】 兰州大学 ， 内科学（专业学位）， 2013， 硕士

【摘要】 目的心肌梗死(myocardial infarction, MI)患者普遍存在左室心肌收缩不同步运动现象,如何准确评价不同步运动对于诊断、治疗及判断预后均具有重要临床意义,也是近年来国内外心脏起搏与电生理学界研究的热点课题。本研究采用实时三平面超声心动图技术(real-time triplane echocardiography, RT-3PE)与组织同步显像技术(Tissue Synchronization Imaging, TSI)相结合即三平面组织同步显像技术(Triplane-TSI)对正常人和心肌梗死患者左室壁运动的同步性进行评价,其主要目的是：1.应用实时三平面组织同步显像技术评价正常人及心肌梗死患者左室心肌的收缩同步性运动,并比较两组间左室收缩不同步参数之间的差异。2.应用实时三平面技术评价正常人与心肌梗死患者左室收缩功能,并与传统二维改良Simpsion法进行比较,探讨三平面超声技术评价左心功能的价值。3.探讨心肌梗死患者左心室心肌收缩不同步与左室心功能的关系。方法应用实时三平面组织同步显像技术(RT3P-TSI),分别测量50例正常人和50例心肌梗死患者(25例前壁MI,25例下壁MI)左室12节段收缩达峰时间期(Ts)及收缩达峰速度(Vp),并得到12节段收缩达峰时间标准差(Ts-SD)和12节段的最大和最小时间的差值(Ts-diff);并采用RT3PE分别测量48例正常人、48例心肌梗死患者左室舒张末期容积(?)(LVEDV)、收缩末期容积(I.VESV)、每搏量(SV)和射血分数(EP),并与二维改良Simpson(?)去所测的LVEDV、LVESV、SV、EF进行比较。结果①前壁和下壁心梗组缩达峰时间(Ts)和对照组相比,Ts明显延长,(P<0.05);前壁心梗组的前壁和前间隔的Ts明显长于对照组和自身其他节段(P<0.05),下壁心梗组的下壁和后壁的Ts明显长于对照组和自身其他节段(P<0.05)；②前壁和下壁心梗组Vp比对照组明显减低(P<0.05)；③前壁心梗组和下壁心梗组不同步指数Ts-diff、Ts-SD比对照组显著延长(P<0.05);④在正常对照组中RT3PE与二维改良Simpson’s法两种方法所测I.VEDV、 LVESV、SV、EF之间差异无统计学意义(P>0.05),并且上述两种方法所测相应的测量值密切相关(r=0.914,0.892,0.815,0.996)；心肌梗死组中RT3PE与二维改良Simpson’s法两种方法所测LVEDV、LVESV、SV、EF之间差异也无统计学意义(P>0.05),并且上述两种方法所测相应的测量值有较好的相关性(r=0.816,0.852,0.798,0.801)⑤实时三平面超声心动图法所测I.VEDV、LVESV、SV, EF在心肌梗死组与对照组之间比较之间差异均有统计学意义(P<0.05)。⑥左室射血分数(LVEF)与Ts-diff, Ts-SD呈负相关性(r值为-0.652,-0.552,P<0.05)。结论心肌梗死患者存在左室收缩功能损害及不同步运动,且两者之间存在良好的负相关性,三平面组织同步显像技术为准确评价不同部位心肌梗死患者左室功能及收缩不同步运动提供了新方法。更多还原

【Abstract】 Objective Left ventricular systolic dyssynchrony widely exists in patients with myocardial infarction(MI),so how to evaluate the myocardial dyssynchrony accurately plays an important clinical role in the diagnosis,treatment and judgment of prognosis.It has been a hot topic in cardiac pacing and electrophysiology in recent years throughout the world. This study is to evaluate left ventricular systolic dyssynchrony in patients with myocardial infarction by real-time three-triplane echocardiography tissue synchronization imaging (RT3P-TSI),combing TSI and RT-3PE.The purposes of this study were:1.To evaluate left ventricular systolic dyssynchrony in patient with myocardial infarction by real-time three-triplane echocardiography tissue synchronization imaging (RT3P-TSI).2.To verify the accuracy of left ventricular systolic function(LVSF) in myocardial infarction patients by Two-dimensional echocardiography (2DE) modoified Simpson’s methods and real-time tri-plane echocardiography(RT-3PE),and to explore whether RT-3PE is a quick and accurate ultrasonic technology for the measurement of LVSF.3. To assess the relationship between the Left ventricular dyssynchrony indexes Ts-diff. Ts-SD and Left ventricular systolic function.Methods50controls and50MI patients (Twenty-five anterior MI and Twenty-five inferior MI patients) were enrolled in this study. The time and velocity to regional peak systolic velocity(Ts),(Vp) in six basal and six middle segments (12segments) of the left ventricular were measured semiautomatically using RT3P-TSI and two parameters of systolic dyssynchrony were computed (Ts-diff and Ts-SD). The left ventricular end-diastolic volume (LVEDV),Jeft ventricular end-systolic volume (LVESV),stroke volume (SV) and left ventricular ejection fraction (LVEF) were measured to the control group and MI patients by2DE modoified Simpson’s methods and RT-3PE. Results①Ts delays in anterior segments and interventricular septum in anterior MI group (P<0.05). Ts delayed in anterior segments and inlerventricular septum in anterior MI group (P<0.05). Ts delayed in inferior and posterior segments in inferior MI group (P<0.05).Ts of lateral was prolonged in the MI group compared with controls (P<0.05).②Vp was significantly shortest in MI group when compared with controls.③The Ts-SD and Ts-diff were prolonged in the anterior MI group and inferior MI group when compared with controls (P<0.05).④n normal people there were no statistically significant difference among the values of LVEDV、LVESV、SV and LVEF.there was good correlation between RT-3PE and2DE Simpson’s methods(r=0.914,0.892,0.815,0.996), Furthermore, In MI people there were no statistically significant difference among the values of LVEDV、LVESV、SV and LVEF between RT-3PE and2DE Simpson’s methods.There was good correlation between RT-3PE and2DE Simpson’s methods(r=0.816,0.852,0.798,0.801)⑤The values of LVEDV、LVESV、SV and LVEF were measured by RT-3PE in MI patients and the control group,has statistically significant difference⑥eft ventricular of ejection fraction (LVEF) is correlated negatively with he dyssynchrony indexes Ts-diff、Ts-SD (r=-0.652,-0.552, P<0.05).Conclusion.the systolic dyssynchrony of LV was damaged is common in MI patients. LVEF is correlated negatively with the two parameters of dyssynchrony indexes.Triplane TSI is a new and accurate methods in assessment of left ventricular dyssychrony.更多还原