应用组织多普勒成像技术对冠心病心肌梗塞患者左室整体功能的评价.docVIP

应用组织多普勒成像技术对冠心病心肌梗塞患者左室整体功能的评价 摘要 目的 检测冠心病心肌梗塞患者左室整体功能，力图寻找与左室功能相关性良好的多普勒超声心动图参数以作为临床评价的主要依据。方法 对经临床及冠状动脉造影确证的心肌梗塞（1～6个月）患者41例行多普勒超声心动图检查。根据其二尖瓣口血流频谱形态将患者分为三组：1、左室松弛性减低组，2、假性正常化组，3、限制性充盈组；又根据EF值将患者分为两组：1、EF≥50%, 2、EF50%，将各多普勒超声心动图参数在各组及健康对照组之间对比分析。结果 随着心脏舒张功能障碍进展，TDI测得的Em值及Em/Am比值降低（p=0.0000.01），其显著性差别尤其表现在对照组与左室松弛性减低组及假性正常化组（分别为p=0.0000.01；p=0.0010.01）。在正常对照组、冠心病心肌梗塞EF正常组及冠心病心肌梗塞EF减低组TDI测得的Sm、Em及Em/Am比值呈逐渐降低趋势（p=0.0000.01）。而且Spearman相关分析表明：Em值及Em/Am比值与左室舒张功能障碍分级相关性良好，相关系数分别为ρs=-0.6907、ρs=-0.6069 （p=0.0000.01）；Sm与EF值相关性良好，相关系数为ρs=0.6202（p=0.0000.01）。结论 冠心病心肌梗塞患者出现左室舒张功能障碍常先于左室收缩功能障碍，TDI测得的Em及Em/Am比值可用于鉴别左室舒张功能的假性正常化；TDI测得的Sm可作为评估冠心病心肌梗塞患者左室收缩功能的重要参数，结合其他超声心动图指标可更为全面地对患者进行临床评价。 关键词 组织多普勒成像 心肌梗塞 左室舒张功能 左室收缩功能 The Clinical Study of Assessment of Left Ventricular Allomeric Function With Tissue Doppler Imaging in Patients of Myocardial infarction Abstract Objective Detecting the left ventricular allomeric function in patients of myocardial infarction , to seek variables which have close correlations with the left ventricular allomeric function to use in clinical evaluation. Methods Doppler echocardiolgraph was performed in 41 patients of myocardial infarction with various stages of diastolic and systolic dysfunction and 40 normal controls .The patients were divided into 3 groups according their mitral flow spectrum:1 delayed left ventricular relaxation ;2 psudonormal left ventricular filling; 3 restrictive left ventricular filling, and into 2 groups according their ejection fraction EF: 1 EF50%; 2 EF50%, all of their variables are contrasted with healthy controls.Results With the deteriorating of the left ventricular diastolic dysfunction, significant differences were found in Em and Em/Am ratio （p=0.0000.01）detected by Doppler tissue imaging , especially between the group of healthy control and delayed left ventricular relaxation (p=0.0000.01)and between the group of healthy control and psudonormal left ventricular filling (p=0.0010.01). Sm、Em and Em/A