CAJ | 학술논문

目的：探讨超声心动图对外科术前患者无症状性心肌缺血的诊断价值。方法选取172例外科术前疑似诊断为冠心病的患者，按手术类型分为心瓣膜手术组（72例）和非心瓣膜手术组（100例），均于术前2周内施行过超声心动图检查和冠状动脉造影术，分析超声心动图中室壁节段运动异常（RWMA）和室壁运动积分指数（WMSI）诊断外科术前患者无症状性心肌缺血的灵敏度、特异度、准确率等统计学指标。结果以冠状动脉造影作为冠心病诊断金标准，RW M A诊断心瓣膜手术组、非心瓣膜手术组无症状性心肌缺血的灵敏度分别为85．7％、100．0％，特异度分别为100．0％、80．0％，两组差异无统计学意义（ P＞0．05）。心瓣膜手术组和非心瓣膜手术组最大受试者工作特征曲线（ROC曲线）下面积的WMSI分别为2．20和2．05，其对应的灵敏度分别为79．7％、75．9％，特异度分别为83．0％、67．7％，ROC曲线下面积分别为0．832、0．702，但两组比较差异无统计学意义（ P＞0．05）。结论采用超声心动图中的RWMA和WMSI作为参考指标诊断外科术前患者无症状性心肌缺血具有较好的灵敏度、特异度、准确率，且对心瓣膜手术和非心瓣膜手术差异无统计学意义。
목적：탐토초성심동도대외과술전환자무증상성심기결혈적진단개치。방법선취172예외과술전의사진단위관심병적환자，안수술류형분위심판막수술조（72례）화비심판막수술조（100례），균우술전2주내시행과초성심동도검사화관상동맥조영술，분석초성심동도중실벽절단운동이상（RWMA）화실벽운동적분지수（WMSI）진단외과술전환자무증상성심기결혈적령민도、특이도、준학솔등통계학지표。결과이관상동맥조영작위관심병진단금표준，RW M A진단심판막수술조、비심판막수술조무증상성심기결혈적령민도분별위85．7％、100．0％，특이도분별위100．0％、80．0％，량조차이무통계학의의（ P＞0．05）。심판막수술조화비심판막수술조최대수시자공작특정곡선（ROC곡선）하면적적WMSI분별위2．20화2．05，기대응적령민도분별위79．7％、75．9％，특이도분별위83．0％、67．7％，ROC곡선하면적분별위0．832、0．702，단량조비교차이무통계학의의（ P＞0．05）。결론채용초성심동도중적RWMA화WMSI작위삼고지표진단외과술전환자무증상성심기결혈구유교호적령민도、특이도、준학솔，차대심판막수술화비심판막수술차이무통계학의의。
Objective To study the value of echocardiogram in preoperative examination for the diagnosis of silent myocardial is-chemia in patients before surgery .Methods 172 patients with surgical preoperative suspected diagnosis of coronary heart disease , were divided into heart valve surgery group (72 cases) and non heart valve surgery group (100 cases) .All of the patients had echo-cardiography and coronary angiography before 2 weeks of operation .We drew a series of analysis to assess the sensitivity、specialty and accuracy of diagnosis of silent myocardial ischemia with regional wall motion abnormality (RWMA) and wall motion score in-dex (WMSI) .Results Coronary angiography as the gold standard of coronary heart disease diagnosis .The sensitivity of RWMA for the diagnosis of silent myocardial ischemia in patients undergoing heart valve surgery group and non heart valve surgery group was 85 .7% and 100 .0% ,while the specificity of RWMA was 100 .0% and 80 .0% ,respectively ,the differences between the two groups had no statistical significance (P>0 .05) .We also drew the ROC curve of WMSI for the diagnosis of silent myocardial ische-mia ,maximum area under the ROC curve of WMSI were 2 .20 and 2 .05 .In patients undergoing cardiac surgery and non-cardiac sur-gery ,the curves indicated that the sensitivity were 79 .7% and 75 .9% ,the specificity were 83 .0% and 67 .7% ,respectively .Area under the ROC curve was 0 .832 and 0 .702 ,but the difference was not statistically significant (P>0 .05) .Conclusion Using RW-MA and WMSI as reference indicators ,surgical preoperative echocardiography in the diagnosis of patients with silent myocardial is-chemia has good sensitivity ,specific ,and accurate ,there is no statistically significant difference between heart valve surgery and non heart valve surgery .