多巴酚丁胺负荷超声心动图对左室心尖部血栓及存活心肌探究.docVIP

多巴酚丁胺负荷超声心动图对左室心尖部血栓及存活心肌探究 　　　　　　　　　　　　作者：杨兴益 康春松 温继军 武燕 【关键词】 左室血栓 　　【摘要】 目的 旨在探讨是否在常规2-DE左室心尖部血栓的出现预示无存活心肌的存在。 方法 80例心肌梗死患者接受DSE检查，根据心室内有无血栓分为血栓组（1组）及无血栓组（2组），比较两组的室壁运动积分及射血分数。 结果 48例患者被证实高度怀疑有左室血栓（1组），32例患者无左室血栓（2组）。1组比2组有更高的室壁积分;1组的32例（67%）及2组中8例（25%）患者证明在心尖节段无收缩储备即无存活心肌。 结论 在无存活心肌存在的相应节段左室心尖部血栓更易出现。 　　关键词 多巴酚丁胺负荷超声心动图 左室血栓 心肌存活 　　Study on the dobutamine stress echocardiographic test for left ventricular apical thrombus and myocardial viability 　　【Abstract】 Objective The aim of this article was to determine whether the presence of left ventricular throm-bus is a marker of nonviable myocardium.Methods Eighty patients with myocardial infarction（MI）were studied by dobutamine stress echocardiography（DSE）left ventricular apical was identified using echocardiographic criteria;thus，the patients were divided into two groups，those with definite and highly suspicious echocardiograms for left ventricular thrombus（group1）and those without echocardiographic evidence of thrombus（group2）.The wall motion score（WMS）and left ventricular ejection fraction（LVEF）in group1were compared with those in group2.Results 48patients had definite or highly suspicious findings for left ventricular thrombus（group1），and32patients had no thrombus（group2）.Group1had significantly higher WMS and LVEF compared to those in group2，thirty-two pa-tients（67%）in group1demonstrated no contractile reserve in the apical segments;consistent with lack of viability，versus eight patients（25%）in group2.Conclusion Left ventricular apical thrombus is more likely to be present when there is absence at myocardial viability in the corresponding segments. 　　Key words dobutamine stress echocardiography ventricular thrombus myocardial viability 　　冠心病心肌梗死引起的冠脉血流下降可导致可逆性的室壁运动异常。严重的节段性室壁运动异常也易引起左室血栓形成。左室心尖部血栓与存活心肌间的关系研究较少，所以进行本研究。 　　1 资料与方法 　　1.1 一般资料 经冠脉造影证实心肌梗死患者80例，接受DSE检查。其中男64例，女16例，年龄28～85岁，见表1。 　　1.2 仪器与方法 仪器用HP sonos5500型彩色超声诊断仪，S4变频探头，内置负荷软件分析系统。试验前6～8h禁食，停用影响心肌收缩力的药物。在全过程持续心率、血压、心电图监测，患者左侧卧位，多巴酚丁胺起始剂量