本文選題：經(jīng)胸超聲心動(dòng)圖　切入點(diǎn)：實(shí)時(shí)三維　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用經(jīng)胸實(shí)時(shí)三維超聲心動(dòng)圖(RT 3D-TTE)研究急性心肌梗死(AMI)患者不同二尖瓣反流(MR)程度、不同梗死部位的二尖瓣構(gòu)型變化,為AMI合并MR患者的治療提供依據(jù)。方法:急性心�；颊�89例,年齡39~76歲,平均(52±11)歲,急性心梗后72h內(nèi)行超聲心動(dòng)圖檢查。根據(jù)彩色多普勒超聲分為無反流組27例和反流組62例,反流組根據(jù)有效反流口面積(EROA)分為輕度MR組35例,中重度MR組27例;根據(jù)梗死部位不同,分為前壁病變組50例和下后壁病變組39例。正常對(duì)照組30例,年齡38-78歲,平均(52±17)歲。應(yīng)用二維超聲獲得左室舒張末期內(nèi)徑(LVEDD)、收縮末期內(nèi)徑(LVESD),應(yīng)用TomTec分析軟件脫機(jī)分析獲得左室舒張末期容積(LVEDV)、收縮末期容積(LVESV)、左室射血分?jǐn)?shù)(LVEF)和二尖瓣環(huán)參數(shù)。比較急性心梗無反流組、反流組、對(duì)照組間的常規(guī)超聲心動(dòng)圖參數(shù)、二尖瓣環(huán)參數(shù);比較急性心梗合并不同程度MR組間的常規(guī)超聲心動(dòng)圖參數(shù)、二尖瓣環(huán)參數(shù);比較不同梗死部位、合并不同程度MR組間的二尖瓣環(huán)參數(shù);比較合并同等程度MR、不同梗死部位組間的常規(guī)超聲心動(dòng)圖參數(shù)、二尖瓣環(huán)參數(shù)。結(jié)果:1.急性心梗無反流組與對(duì)照組比較,瓣環(huán)周長(zhǎng)(AC)、非平面角度(NPA)增大;急性心梗合并反流組與對(duì)照組比較:反流組的瓣環(huán)前后直徑(AP)、瓣環(huán)前外側(cè)后內(nèi)側(cè)直徑(AL-PM)、瓣環(huán)聯(lián)合處直徑(CD)、瓣環(huán)周長(zhǎng)(AC)、瓣環(huán)二維面積(AA2D)、瓣環(huán)三維面積(AA3D)、幕狀區(qū)容積(TV)、幕狀區(qū)高度(TH)、非平面角度(NPA)均增大(p均0.05),瓣環(huán)高度(AH)、瓣環(huán)最大位移(ADMax)、最大位移速率(ADVMax)均減小(p均0.05)。2.不同程度MR組間比較,無反流組、輕度MR組、中重度MR組中AP、AC、CD、AA2D、AA3D、TV、TH逐漸增大,差異均有統(tǒng)計(jì)學(xué)意義(p均0.05);中重度MR組AL-PM大于輕度MR組(p0.05),AH、ADMax小于輕度MR組(p均0.05),輕度MR組與無反流組比較差異無統(tǒng)計(jì)學(xué)意義(p均0.05),ADVMax反流組組間比較差異無統(tǒng)計(jì)學(xué)意義(p0.05)。3.不同梗死部位,不同程度MR組間比較:中重度MR組AP、AL-PM、AC、CD、AA2D、AA3D、TV、TH大于輕度組,AH小于輕度MR組(p均0.05)。4.不同梗死部位合并同等程度MR組間比較,下后壁病變合并中重度MR組AA2D、AA3D大于前壁病變組,大于對(duì)照組(p均0.05),下后壁病變合并輕度MR組AP、AL-PM、AC、CD、AA2D、AA3D、TV、TH、AH、ADMax、ADVMax與前壁病變組差異無統(tǒng)計(jì)學(xué)意義(p均0.05)。結(jié)論:1.急性心梗無二尖瓣反流者,部分二尖瓣環(huán)結(jié)構(gòu)發(fā)生變化;合并二尖瓣反流者,隨著反流程度加重,二尖瓣環(huán)擴(kuò)大越明顯,馬鞍形立體結(jié)構(gòu)越趨于扁平,運(yùn)動(dòng)能力減弱。2.同等程度MR不同部位心梗者,下后壁心梗致二尖瓣環(huán)面積擴(kuò)大更明顯。3.實(shí)時(shí)經(jīng)胸三維超聲心動(dòng)圖可用來研究二尖瓣構(gòu)型變化,為臨床選擇治療方案提供一定的參考。
[Abstract]:Objective: to study the changes of mitral valve configuration in patients with acute myocardial infarction (AMI) with different degree of mitral regurgitation (MRV) and different infarct site by transthoracic real-time three-dimensional echocardiography (RT3D-TTER), and to provide evidence for the treatment of AMI with Mr.Methods: 89 patients with acute myocardial infarction aged 3976 years (mean 52 鹵11) years were examined by echocardiography within 72 hours after acute myocardial infarction.According to color Doppler ultrasound, 27 cases were divided into no reflux group (n = 27) and reflux group (n = 62). Reflux group (n = 35) was divided into mild Mr group (n = 35) and moderate or severe Mr group (n = 27) according to effective reflux area.The patients were divided into anterior wall lesion group (n = 50) and inferior posterior wall lesion group (n = 39).30 cases of normal control group, age 38-78 years old, mean 52 鹵17 years old.Left ventricular end-diastolic dimension (LVED) and end-systolic diameter (LVESD) were obtained by two-dimensional echocardiography. Left ventricular end-diastolic volume (LVEDVV), end-systolic volume (LVESVV), left ventricular ejection fraction (LVEF) and mitral annulus parameters were obtained by TomTec software off-line analysis.The parameters of conventional echocardiography, mitral annulus and mitral annulus in patients with acute myocardial infarction without reflux, reflux group and control group were compared, and the parameters of conventional echocardiography and mitral annulus in acute myocardial infarction with different degree of Mr were compared.The mitral annular parameters of different infarct sites and different degree of Mr were compared, and the conventional echocardiographic parameters and mitral annular parameters of different infarct locations were compared.The result is 1: 1.Compared with the control group, the annular circumference was increased in the acute myocardial infarction without reflux group.Comparison of acute myocardial infarction with regurgitation group: the anterior and posterior annular diameter of the regurgitation group was AL-PMN, the anterolateral posterior medial diameter of the annulus was AL-PMN, the diameter of the annular junction was CDI, the circumferential annular AAC, the 2-D area of the annular, the three-dimensional area of the annulus, the volume of the tentorial region.The height of TVB, the height of tabular area and the non-plane angle NPAs are all increased, the height of annular is 0.05g, the height of annular is AHHN, the maximum displacement of annulus is AHX, and the maximum displacement rate and the maximum rate of displacement are all decreased by 0.05n.2.Compared with Mr group of different degree, the th of ACA CDA2D AA-3D TV-TH increased gradually in no reflux group, mild Mr group, moderate and severe Mr group, and no reflux group, mild Mr group and moderate or severe Mr group.Comparison of different infarct sites and different degrees of Mr: APAL-PMMA ACU AL-PMN in moderate and severe Mr group was higher than that in mild Mr group (P < 0.05), and the ratio of AH in AH was higher than that in mild Mr group (P < 0.05).Conclusion 1.In patients with acute myocardial infarction without mitral regurgitation, some mitral annular structures changed, and in patients with mitral regurgitation, the enlargement of mitral annulus became more obvious, the saddle shape became flat, and the motor ability decreased with the increase of mitral regurgitation.The area of mitral annulus increased more significantly in patients with different MI in the same degree than that in inferior posterior wall myocardial infarction.Real-time three-dimensional echocardiography can be used to study mitral valve configuration and provide some reference for clinical treatment.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22;R540.45

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