CAJ | 학술논문

目的：探讨应用实时三维超声心动图（ RT-3DE）评价急性心肌梗死患者经皮冠状动脉介入治疗（ PCI）前后左心室局部功能变化的应用价值。方法选取2012年12月—2013年12月佳木斯大学附属第一医院接受PCI的急性心肌梗死患者46例为病例组，其中下后壁心肌梗死组27例，下壁心肌梗死组19例；另选择同时期体检中心体检健康者30例为对照组，对照组于体检时，病例组于PCI前、PCI后1、4、12周分别做RT-3DE检查，记录左心室各节段舒张末期容积（ rEDV）及左心室各节段收缩末期容积（ rESV），并计算出各节段射血分数（ rEF）。结果对照组RT-3DE左心室各节段容积-时间曲线规整有序，病例组患者PCI前RT-3DE左心室各节段容积-时间曲线杂乱无序。对照组与下后壁心肌梗死组PCI前及PCI后1周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段rEF比较，差异有统计学意义（P<0.05）；对照组与下后壁心肌梗死组PCI后4周下壁中间段、后壁中间段rEF比较，差异有统计学意义（ P<0.05）。下后壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段rEF比较，差异有统计学意义（ P<0.05）；其中PCI后1周后壁中间段rEF较PCI前升高（P<0.05）；PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段rEF较PCI前及PCI后1周升高（P<0.05）；PCI后12周下壁中间段、后壁中间段rEF较PCI后4周升高（P<0.05）。对照组与下壁心肌梗死组PCI前、PCI后1周及PCI后4周下壁基底段、下壁中间段、下壁心尖段rEF比较，差异有统计学意义（ P<0.05）。下壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段rEF比较，差异有统计学意义（P<0.05）；其中PCI后4周及PCI后12周下壁基底段、下壁心尖段rEF较PCI前及PCI后1周升高（P<0.05）；PCI后12周下壁中间段rEF较PCI前及PCI后1周升高（P<0.05）。结论 RT-3DE可较准确反映急性心肌梗死患者PCI前后左心室局部收缩功能的变化，可作为评价PCI疗效的有效方法。目的：探討應用實時三維超聲心動圖（ RT-3DE）評價急性心肌梗死患者經皮冠狀動脈介入治療（ PCI）前後左心室跼部功能變化的應用價值。方法選取2012年12月—2013年12月佳木斯大學附屬第一醫院接受PCI的急性心肌梗死患者46例為病例組，其中下後壁心肌梗死組27例，下壁心肌梗死組19例；另選擇同時期體檢中心體檢健康者30例為對照組，對照組于體檢時，病例組于PCI前、PCI後1、4、12週分彆做RT-3DE檢查，記錄左心室各節段舒張末期容積（ rEDV）及左心室各節段收縮末期容積（ rESV），併計算齣各節段射血分數（ rEF）。結果對照組RT-3DE左心室各節段容積-時間麯線規整有序，病例組患者PCI前RT-3DE左心室各節段容積-時間麯線雜亂無序。對照組與下後壁心肌梗死組PCI前及PCI後1週下壁基底段、下壁中間段、下壁心尖段、後壁基底段、後壁中間段rEF比較，差異有統計學意義（P<0.05）；對照組與下後壁心肌梗死組PCI後4週下壁中間段、後壁中間段rEF比較，差異有統計學意義（ P<0.05）。下後壁心肌梗死組患者PCI前、PCI後1週、PCI後4週及PCI後12週下壁基底段、下壁中間段、下壁心尖段、後壁基底段、後壁中間段rEF比較，差異有統計學意義（ P<0.05）；其中PCI後1週後壁中間段rEF較PCI前升高（P<0.05）；PCI後4週及PCI後12週下壁基底段、下壁中間段、下壁心尖段、後壁基底段、後壁中間段rEF較PCI前及PCI後1週升高（P<0.05）；PCI後12週下壁中間段、後壁中間段rEF較PCI後4週升高（P<0.05）。對照組與下壁心肌梗死組PCI前、PCI後1週及PCI後4週下壁基底段、下壁中間段、下壁心尖段rEF比較，差異有統計學意義（ P<0.05）。下壁心肌梗死組患者PCI前、PCI後1週、PCI後4週及PCI後12週下壁基底段、下壁中間段、下壁心尖段rEF比較，差異有統計學意義（P<0.05）；其中PCI後4週及PCI後12週下壁基底段、下壁心尖段rEF較PCI前及PCI後1週升高（P<0.05）；PCI後12週下壁中間段rEF較PCI前及PCI後1週升高（P<0.05）。結論 RT-3DE可較準確反映急性心肌梗死患者PCI前後左心室跼部收縮功能的變化，可作為評價PCI療效的有效方法。
목적：탐토응용실시삼유초성심동도（ RT-3DE）평개급성심기경사환자경피관상동맥개입치료（ PCI）전후좌심실국부공능변화적응용개치。방법선취2012년12월—2013년12월가목사대학부속제일의원접수PCI적급성심기경사환자46례위병례조，기중하후벽심기경사조27례，하벽심기경사조19례；령선택동시기체검중심체검건강자30례위대조조，대조조우체검시，병례조우PCI전、PCI후1、4、12주분별주RT-3DE검사，기록좌심실각절단서장말기용적（ rEDV）급좌심실각절단수축말기용적（ rESV），병계산출각절단사혈분수（ rEF）。결과대조조RT-3DE좌심실각절단용적-시간곡선규정유서，병례조환자PCI전RT-3DE좌심실각절단용적-시간곡선잡란무서。대조조여하후벽심기경사조PCI전급PCI후1주하벽기저단、하벽중간단、하벽심첨단、후벽기저단、후벽중간단rEF비교，차이유통계학의의（P<0.05）；대조조여하후벽심기경사조PCI후4주하벽중간단、후벽중간단rEF비교，차이유통계학의의（ P<0.05）。하후벽심기경사조환자PCI전、PCI후1주、PCI후4주급PCI후12주하벽기저단、하벽중간단、하벽심첨단、후벽기저단、후벽중간단rEF비교，차이유통계학의의（ P<0.05）；기중PCI후1주후벽중간단rEF교PCI전승고（P<0.05）；PCI후4주급PCI후12주하벽기저단、하벽중간단、하벽심첨단、후벽기저단、후벽중간단rEF교PCI전급PCI후1주승고（P<0.05）；PCI후12주하벽중간단、후벽중간단rEF교PCI후4주승고（P<0.05）。대조조여하벽심기경사조PCI전、PCI후1주급PCI후4주하벽기저단、하벽중간단、하벽심첨단rEF비교，차이유통계학의의（ P<0.05）。하벽심기경사조환자PCI전、PCI후1주、PCI후4주급PCI후12주하벽기저단、하벽중간단、하벽심첨단rEF비교，차이유통계학의의（P<0.05）；기중PCI후4주급PCI후12주하벽기저단、하벽심첨단rEF교PCI전급PCI후1주승고（P<0.05）；PCI후12주하벽중간단rEF교PCI전급PCI후1주승고（P<0.05）。결론 RT-3DE가교준학반영급성심기경사환자PCI전후좌심실국부수축공능적변화，가작위평개PCI료효적유효방법。
Objective To investigate the application value of RT-3DE in the evaluation of the local function changes in the left ventricle of patients with acute myocardial infarction before and after percutaneous coronary intervention ( PCI ). Methods Enrolled 46 patients with acute myocardial infartion who received PCI in the First Affiliated Hospital of Jiamusi University from December 2012 to December 2013 as the case group. The subjects who had myocardial infarction in the inferior posterior wall were assigned into inferior posterior wall group(n=27),and the subjects who had myocardial infarction in the inferior wall were assigned into the inferior wall group(n=19). Another 30 healthy people who received physical examination in the same hospital during the same period were enrolled as the control group. The control group received RT-3DE during physical examination,and the case group received RT-3DE before PCI and at week 1,week 4 and week 12 after PCI,then rEDV and rESV of each segment of the left ventricular were recorded and the rEF of each segment was calculated. Results The RT-3DE volume-time curves were regular and ordered in each segment of left ventricular in the control group and were irregular and disordered in the case group. The control group and the inferior posterior wall group were significantly different(P<0. 05)in the rEF of inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment before PCI and at week 1 after PCI. The control group and the inferior posterior wall group were significantly different( P<0. 05)in the rEF of inferior middle segment and posterior middle segment at week 4 after PCI. Before PCI and at week 1,4, 12 after PCI were significantly different(P<0. 05)in the rEF of inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment in the inferior posterior wall group;the inferior posterior wall group had higher(P<0. 05)rEF in posterior middle segment at week 1 after PCI than that before PCI;the inferior posterior wall group had higher(P<0. 05)rEF in inferior basal segment,inferior middle segment,inferior vertex segment,posterior basal segment and posterior middle segment at week 4 and week 12 after PCI than that before PCI and at week 1 after PCI;the inferior posterior wall group had higher(P<0. 05)rEF in inferior middle segment and posterior middle segment at week 12 after PCI than that at week 4 after PCI. The control group and the inferior wall group were significantly different(P<0. 05)in the rEF of inferior basal segment,inferior middle segment and inferior vertex segment before PCI and at week 1 and week 4 after PCI. Before PCI and at week 1,4,12 after PCI were significantly different(P <0. 05)in the rEF of inferior basal segment,inferior middle segment and inferior vertex segment in the inferior wall group;the inferior wall group had higher(P<0. 05)rEF in inferior basal segment and inferior vertex segment at week 4 and week 12 after PCI than that before PCI and at week 1 after PCI;the inferior wall group had higher(P<0. 05)rEF in inferior middle segment at week 12 after PCI than that before PCI and at week 1 after PCI. Conclusion RT-3DE can accurately reflect the changes of local systolic function of left ventricular after PCI and can be used as an effective method of evaluating the curative effect of PCI.