單心動(dòng)周期三維超聲評(píng)價(jià)冠心病患者PCI術(shù)前后左心室功能及同步性研究
發(fā)布時(shí)間：2019-06-18 17:08
【摘要】：目的：探討單心動(dòng)周期實(shí)時(shí)三維超聲心動(dòng)圖（sRT-3DE）評(píng)價(jià)冠狀動(dòng)脈左前降支（LAD）病變的急性心肌梗死（AMI）和慢性穩(wěn)定性冠心病患者經(jīng)皮冠狀動(dòng)脈介入治療（PCI）后左心室功能及同步性參數(shù)的早期變化情況，以及左心室功能及同步性指標(biāo)與狹窄程度之間的相關(guān)性，為PCI提供了術(shù)前評(píng)價(jià)及術(shù)后近期療效的評(píng)估。 方法：選擇LAD行PCI的AMI患者（39例）及慢性穩(wěn)定性冠心病患者（48例），于術(shù)前及術(shù)后1周分別行sRT-3DE檢查，，獲得以下左室功能及同步性參數(shù)，左心室功能性參數(shù)：射血分?jǐn)?shù)（EF）、心縮末期容積（ESV）、心舒末期容積（EDV）、心搏量（SV）、心縮末期球形指數(shù)（ESSI）、心舒末期球形指數(shù)（EDSI），左心室收縮同步性參數(shù)：16節(jié)段心縮非同步指數(shù)（SDI16）、16節(jié)段心縮末期離散度（DISPES16）、16節(jié)段心縮末期平均時(shí)間（MES16）、16節(jié)段收縮前時(shí)間與容積（Pre Contr16）、16節(jié)段收縮后時(shí)間與容積（Post Contr16），左心室舒張同步性參數(shù)：16節(jié)段心舒非同步指數(shù)（DDI16）、16節(jié)段心舒末期離散度（DISPED16）、16節(jié)段心舒末期平均時(shí)間（MED16）、16節(jié)段舒張前時(shí)間與容積（Pre Relax16）、16節(jié)段舒張后時(shí)間與容積（Post Relax16）。對(duì)于以上參數(shù)，根據(jù)改良Gensini評(píng)分將AMI組及慢性穩(wěn)定性冠心病組均再分為輕、中、重度三組，同組研究對(duì)象比較術(shù)前、術(shù)后參數(shù)的差異，全部研究對(duì)象的16個(gè)術(shù)前指標(biāo)分別與狹窄程度進(jìn)行相關(guān)性研究。采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析，患者術(shù)前、術(shù)后比較采用配對(duì)t檢驗(yàn)，以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義；相關(guān)分析采用Spearman相關(guān)，檢驗(yàn)水平均為α=0.05，以P＜0.05有相關(guān)性。 結(jié)果：AMI的輕、中、重度組均術(shù)后1周EF、SV高于術(shù)前（P＜0.05），ESV、EDV、 ESSI、 EDSI、 SDI、 DISPES、 MES、 Pre Contr、 Post Contr、 DDI、DISPED、MED、Pre Relax、Post Relax低于術(shù)前（P＜0.05）；慢性穩(wěn)定性冠心病輕、中度組術(shù)后1周EF、SV、ESV、EDV、ESSI、EDSI、SDI、DISPES、MES、PreContr、Post Contr、DDI、DISPED、MED、Pre Relax、Post Relax與術(shù)前相比無統(tǒng)計(jì)學(xué)意義（P＞0.05），慢性穩(wěn)定性冠心病重度組術(shù)后1周EF、SV高于術(shù)前（P＜0.05），ESV、EDV、ESSI、EDSI、SDI、DISPES、MES、Pre Contr、Post Contr、DDI、DISPED、MED、Pre Relax、Post Relax低于術(shù)前（P＜0.05）；左室功能及同步性與狹窄程度無相關(guān)性（P＞0.05）。 結(jié)論：AMI患者PCI術(shù)后1周左室功能和同步性較術(shù)前改善；改良Gensini評(píng)分相對(duì)較低的輕中度慢性穩(wěn)定型冠心病患者PCI術(shù)后1周左室功能及同步性較術(shù)前無明顯變化，改良Gensini評(píng)分相對(duì)較高的重度慢性穩(wěn)定性冠心病患者術(shù)后1周左室功能及同步性較術(shù)前有所改善。
[Abstract]:Objective: to investigate the early changes of left ventricular function and synchronization parameters in patients with acute myocardial infarction (AMI) with left anterior descending coronary artery disease (LAD) and patients with chronic stable coronary heart disease (LAD) after percutaneous coronary intervention (PCI), and the correlation between left ventricular function and synchronization and the degree of stenosis. It provides the preoperative evaluation and the evaluation of the short-term curative effect after operation for PCI. Methods: 39 patients with AMI and 48 patients with chronic stable coronary heart disease underwent PCI with LAD. SRT-3DE was performed before and 1 week after operation. The following left ventricular function parameters and left ventricular functional parameters were obtained: ejection fraction (EF), end systolic volume (ESV), diastolic end volume (EDV), systolic end volume (SV), cardiac systolic end spherical index (EDSI),. Left ventricular systolic synchronization parameters: 16 segment systolic asynchronous index (SDI16), 16 segment end systolic dispersion (DISPES16), 16 segment end systolic mean time (MES16), 16 segment presystolic time and volume (Pre Contr16), 16 segment post systolic time and volume (Post Contr16), left ventricular diastolic synchronization index (DDI16), 16 segment end diastolic dispersion (DISPED16), The mean diastolic time (MED16), prediastolic time and volume (Pre Relax16) and postdiastolic time and volume (Post Relax16) of 16 segments were compared with those of 16 segments. According to the modified Gensini score, the AMI group and the chronic stable coronary heart disease group were divided into three groups: mild, moderate and severe. The differences of preoperative and postoperative parameters were compared in the same group. The 16 preoperative indexes of all the subjects were correlated with the degree of stenosis, respectively. The statistical analysis was carried out by SPSS17.0 statistical software. Pairing t test was used to compare the patients before and after operation, the difference was statistically significant (P < 0.05), and the correlation analysis was carried out by Spearman, the test level was 偽 = 0.05, P < 0.05. Results: EF,SV and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax in mild, moderate and severe AMI groups were higher than those before operation one week after operation (P < 0.05), and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax were lower than those before operation (P < 0.05). There was no significant difference in EF,SV,ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax,Post Relax at 1 week after operation in mild and moderate chronic stable coronary heart disease group compared with that before operation. EF,SV in severe chronic stable coronary heart disease group was higher than that before operation (P < 0.05), and ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax, was higher in severe chronic stable coronary heart disease group one week after operation (P < 0.05). Post Relax was lower than that before operation (P < 0.05). There was no correlation between left ventricular function and synchronization and the degree of stenosis (P > 0.05). Conclusion: the left ventricular function and synchronization of AMI patients with PCI were improved 1 week after operation, the left ventricular function and synchronization of patients with mild to moderate chronic stable coronary heart disease with relatively low Gensini score were not significantly different from those before operation, but the left ventricular function and synchronization of patients with severe chronic stable coronary heart disease with higher modified Gensini score were improved one week after operation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541.4;R540.45
本文編號(hào)：2501648
[Abstract]:Objective: to investigate the early changes of left ventricular function and synchronization parameters in patients with acute myocardial infarction (AMI) with left anterior descending coronary artery disease (LAD) and patients with chronic stable coronary heart disease (LAD) after percutaneous coronary intervention (PCI), and the correlation between left ventricular function and synchronization and the degree of stenosis. It provides the preoperative evaluation and the evaluation of the short-term curative effect after operation for PCI. Methods: 39 patients with AMI and 48 patients with chronic stable coronary heart disease underwent PCI with LAD. SRT-3DE was performed before and 1 week after operation. The following left ventricular function parameters and left ventricular functional parameters were obtained: ejection fraction (EF), end systolic volume (ESV), diastolic end volume (EDV), systolic end volume (SV), cardiac systolic end spherical index (EDSI),. Left ventricular systolic synchronization parameters: 16 segment systolic asynchronous index (SDI16), 16 segment end systolic dispersion (DISPES16), 16 segment end systolic mean time (MES16), 16 segment presystolic time and volume (Pre Contr16), 16 segment post systolic time and volume (Post Contr16), left ventricular diastolic synchronization index (DDI16), 16 segment end diastolic dispersion (DISPED16), The mean diastolic time (MED16), prediastolic time and volume (Pre Relax16) and postdiastolic time and volume (Post Relax16) of 16 segments were compared with those of 16 segments. According to the modified Gensini score, the AMI group and the chronic stable coronary heart disease group were divided into three groups: mild, moderate and severe. The differences of preoperative and postoperative parameters were compared in the same group. The 16 preoperative indexes of all the subjects were correlated with the degree of stenosis, respectively. The statistical analysis was carried out by SPSS17.0 statistical software. Pairing t test was used to compare the patients before and after operation, the difference was statistically significant (P < 0.05), and the correlation analysis was carried out by Spearman, the test level was 偽 = 0.05, P < 0.05. Results: EF,SV and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax in mild, moderate and severe AMI groups were higher than those before operation one week after operation (P < 0.05), and ESV,EDV, ESSI, EDSI, SDI, DISPES, MES, Pre Contr, Post Contr, DDI,DISPED,MED,Pre Relax,Post Relax were lower than those before operation (P < 0.05). There was no significant difference in EF,SV,ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax,Post Relax at 1 week after operation in mild and moderate chronic stable coronary heart disease group compared with that before operation. EF,SV in severe chronic stable coronary heart disease group was higher than that before operation (P < 0.05), and ESV,EDV,ESSI,EDSI,SDI,DISPES,MES,PreContr,Post Contr,DDI,DISPED,MED,Pre Relax, was higher in severe chronic stable coronary heart disease group one week after operation (P < 0.05). Post Relax was lower than that before operation (P < 0.05). There was no correlation between left ventricular function and synchronization and the degree of stenosis (P > 0.05). Conclusion: the left ventricular function and synchronization of AMI patients with PCI were improved 1 week after operation, the left ventricular function and synchronization of patients with mild to moderate chronic stable coronary heart disease with relatively low Gensini score were not significantly different from those before operation, but the left ventricular function and synchronization of patients with severe chronic stable coronary heart disease with higher modified Gensini score were improved one week after operation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R541.4;R540.45
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