本文選題：二維斑點(diǎn)追蹤超聲心動(dòng)圖 + 非ST段抬高型心肌梗死��； 參考：《武漢大學(xué)》2016年博士論文

【摘要】：第一部分：二維斑點(diǎn)追蹤超聲心動(dòng)圖評(píng)價(jià)非ST段抬高型心肌梗死患者左室心肌應(yīng)變的臨床價(jià)值目的：應(yīng)用二維斑點(diǎn)追蹤超聲心動(dòng)圖檢測(cè)非ST段抬高型心肌梗死(NSTEMI)患者左室心肌應(yīng)變,探討其在診斷NSTEMI中的臨床價(jià)值。方法：篩選60例急性心肌梗死(AMI)患者,根據(jù)心電圖分為NSTEMI組(30例)、ST段抬高型心肌梗死(STEMI)組(30例),匹配性別與年齡差異無統(tǒng)計(jì)學(xué)意義的對(duì)照組(30例),分別獲取心尖四腔切面、心尖兩腔切面、心尖長軸切面及二尖瓣水平、乳頭肌水平、心尖段水平左室短軸清晰二維圖像,Echo Pac軟件獲取左室的整體收縮峰值縱向應(yīng)變(GLS)及整體收縮峰值環(huán)向應(yīng)變(GCS)、節(jié)段收縮峰值縱向應(yīng)變(TLS)和節(jié)段收縮峰值環(huán)向應(yīng)變(TCS)。結(jié)果：①根據(jù)選擇性冠脈造影(SCA)結(jié)果將NSTEMI組和STEMI組患者左室節(jié)段分為正常節(jié)段和受累節(jié)段；②與對(duì)照組比較,NSTEMI組、STEMI組左室心肌GLS及受累節(jié)段TLS均減低(P0.05)：與NSTEMI組比較,STEMI組左室心肌GLS及受累節(jié)段TLS差異無統(tǒng)計(jì)學(xué)意義；③與對(duì)照組比較,NSTEMI組、STEMI組左室心肌GCS及受累節(jié)段TCS均減低(P0.05)；與NSTEMI組比較,STEMI組左室心肌GCS及受累節(jié)段TCS差異無統(tǒng)計(jì)學(xué)意義；④左室GLS與GCS呈顯著正相關(guān)(r=0.618,P0.001)。結(jié)論：2D-STE技術(shù)左室心肌應(yīng)變參數(shù)能準(zhǔn)確評(píng)價(jià)心肌梗死患者左室心肌縱向及環(huán)向運(yùn)動(dòng),為臨床識(shí)別NSTEMI提供有價(jià)值的信息。第二部分：二維斑點(diǎn)追蹤超聲心動(dòng)圖評(píng)價(jià)非ST段抬高型心肌梗死患者左室心肌分層應(yīng)變的臨床價(jià)值目的：應(yīng)用二維斑點(diǎn)追蹤超聲心動(dòng)圖檢測(cè)非ST段抬高型心肌梗死(NSTEMI)患者左室心外膜下心肌、中層心肌及心內(nèi)膜下心肌分層應(yīng)變,探討其在診斷NSTEMI中的臨床價(jià)值。方法：篩選60例急性心肌梗死(AMI)患者,根據(jù)心電圖分為NSTEMI組(30例)、ST段抬高型心肌梗死(STEMI)組(30例),匹配性別與年齡差異無統(tǒng)計(jì)學(xué)意義的對(duì)照組(30例),分別獲取心尖四腔切面、心尖兩腔切面、心尖長軸切面及二尖瓣水平、乳頭肌水平、心尖段水平左室短軸清晰二維圖像,Echo Pac軟件獲取左室三層心肌的整體收縮峰值縱向應(yīng)變(GLS)及環(huán)向應(yīng)變(GCS)、節(jié)段收縮峰值縱向應(yīng)變(TLS)和環(huán)向應(yīng)變(TCS),并計(jì)算上述應(yīng)變的跨壁梯度ΔGLS、ΔGCS、ΔTLS、ΔTCS。結(jié)果：①根據(jù)選擇性冠脈造影(SCA)結(jié)果將NSTEMI組和STEMI組患者左室節(jié)段分為正常節(jié)段和受累節(jié)段；②與對(duì)照組比較,NSTEMI組、STEMI組左室三層心肌GLS、ΔGLS及受累節(jié)段TLS、ΔTLS均減低(P0.05)；與NSTEMI組比較,STEMI:組左室三層心肌GLS、ΔGLS及受累節(jié)段TLS、ΔTLS差異無統(tǒng)計(jì)學(xué)意義；③與對(duì)照組比較,NSTEMI組、STEMI組左室三層心肌GCS、AGCS及受累節(jié)段TCS、ATCS均減低(P0.05)；與NSTEMI組比較,STEMI組僅心外膜下心肌GCS減低(P0.05),余應(yīng)變指標(biāo)差異無統(tǒng)計(jì)學(xué)意義；④左室心內(nèi)膜下心肌GLS與GCS顯著相關(guān)(r=0.632, P0.001),心外膜下心肌GLS與GCS顯著相關(guān)(r=0.533,P0.001),左室心肌AGLS與AGCS顯著相關(guān)(r=0.369,P0.001)。結(jié)論2D-STE技術(shù)左室心肌分層應(yīng)變參數(shù)能準(zhǔn)確評(píng)價(jià)心肌梗死患者左室心外膜下心肌、中層心肌及心內(nèi)膜下心肌縱向及環(huán)向運(yùn)動(dòng),為臨床識(shí)別NSTEMI提供有價(jià)值信息。
[Abstract]:Part one: the clinical value of two-dimensional speckle tracking echocardiography in evaluating left ventricular myocardial strain in patients with non ST segment elevation myocardial infarction: the use of two-dimensional speckle tracking echocardiography to detect left ventricular myocardial strain in patients with non ST segment elevation myocardial infarction (NSTEMI), and to explore the clinical value of it in the diagnosis of NSTEMI. Method: screening 60 Patients with acute myocardial infarction (AMI) were divided into group NSTEMI (30 cases) and ST segment elevation myocardial infarction (STEMI) group (30 cases), matched with no statistically significant difference between sex and age (30 cases). The apical four cavities, the apical two lumen section, the apical long axis and mitral level, the papillary muscle level, and the apical level were obtained. The left ventricular short axis clear two-dimensional image, Echo Pac software to obtain the overall systolic peak longitudinal strain (GLS) and the overall systolic peak circumferential strain (GCS), segmental peak contraction peak longitudinal strain (TLS) and segment contraction peak circumferential strain (TCS). Results: (1) the left ventricular segment of group NSTEMI and STEMI group patients according to selective coronary angiography (SCA) results. Compared with the control group, the left ventricular myocardium GLS and the affected segment TLS decreased (P0.05) in group NSTEMI and STEMI. Compared with the NSTEMI group, there was no significant difference in the TLS difference between the GLS and the involved segments in the left ventricular myocardium in the STEMI group. (3) compared with the control group, the left ventricular myocardium GCS and involved segments were reduced in the NSTEMI group and STEMI group. 0.05): compared with the NSTEMI group, there was no significant difference between the left ventricular myocardium and the involved segment TCS in the left ventricular myocardium in the STEMI group; (4) there was a significant positive correlation between the left ventricular GLS and GCS (r=0.618, P0.001). Conclusion: the left ventricular myocardial strain parameters of the left ventricular myocardium in 2D-STE technique can accurately evaluate the longitudinal and circumferential movement of left ventricular myocardium in patients with myocardial infarction, and provide valuable for clinical identification of NSTEMI. Information. Second part: the clinical value of two-dimensional speckle tracking echocardiography in evaluating left ventricular myocardial stratified strain in patients with non ST segment elevation myocardial infarction: the use of two-dimensional speckle tracking echocardiography to detect the left ventricular epicardial myocardium in patients with non ST segment elevation myocardial infarction (NSTEMI), the stratification of the middle and sub endocardial myocardium Methods: To explore the clinical value of the diagnosis of NSTEMI. Methods: 60 patients with acute myocardial infarction (AMI) were selected and divided into group NSTEMI (30 cases), ST segment elevation myocardial infarction (STEMI) group (30 cases), and matched group (30 cases) with no statistically significant difference between sex and age (30 cases), respectively, to obtain the apical four lumen section, the apical two lumen section, the heart. Echo Pac software obtained the overall contraction peak longitudinal strain (GLS) and cyclic strain (GCS), the peak longitudinal strain (TLS) and the circumferential strain (TCS) of the three layers of left ventricular myocardium, and calculated the cross wall gradient Delta GLS, Delta GCS, and delta of the above strain. TLS, Delta TCS. results: (1) the left ventricular segment in group NSTEMI and STEMI group was divided into normal segment and involved segment according to the results of selective coronary angiography (SCA); (2) compared with the control group, the three layers of left ventricular myocardium GLS, Delta GLS and TLS, Delta TLS in the left ventricle of group STEMI were reduced (P0.05), and the three layers of left ventricular myocardium were compared with those in the group. There was no significant difference between GLS and TLS and TLS in the affected segments; (3) compared with the control group, the three layers of myocardial GCS, AGCS and TCS in the left ventricle of STEMI group decreased (P0.05) in group NSTEMI, and in the NSTEMI group, only the inferior epicardial myocardium in the STEMI group had no statistical significance; (4) the left ventricular endocardial myocardium was not statistically significant. Significant correlation with GCS (r=0.632, P0.001), GLS in the epicardial myocardium was significantly correlated with GCS (r=0.533, P0.001), and the left ventricular myocardium AGLS was significantly correlated with AGCS (r=0.369, P0.001). Conclusion the LV myocardial stratified strain parameters can accurately evaluate the left ventricular epicardial myocardium in the patients with myocardial infarction, the longitudinal and circumferential myocardium of the middle and endocardial myocardium. Exercise provides valuable information for clinical identification of NSTEMI.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R542.22;R540.45

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