【摘要】：目的：利用實(shí)時(shí)三維超聲心動(dòng)圖(RT-3DE)定量分析急性心肌梗死（AMI）患者PCI術(shù)后左室舒縮功能、左室收縮同步性，評(píng)價(jià)左室重構(gòu)的變化。 方法：對(duì)63例急性心肌梗死PCI術(shù)后患者（A組）及38例健康者（B組）行二維超聲心動(dòng)圖（2DE）、RT-3DE檢查。1、用二維simpson法和RT-3DE測量A、B兩組左室整體收縮功能：左室舒張末容積(EDV)、左室收縮末容積(ESV)、左室射血分?jǐn)?shù)(LVEF)，比較二者測量方法的差異。2、應(yīng)用RT-3DE測量A、B兩組節(jié)段收縮功能（rEDV、rESV、rEF）、節(jié)段最大射血速率與最大充盈速率（rPER、rPFR）、以及左室收縮同步性指標(biāo)：左室16節(jié)段至最小收縮末容量時(shí)間最大差值與標(biāo)準(zhǔn)差及其所在心動(dòng)周期的百分比（Tmsvl6-Dif、Tmsvl6-Dif%、Tmsvl6-SD、Tmsvl6-SD%），比較兩組各參數(shù)的差異，，并將心梗組EF與左室收縮同步性參數(shù)進(jìn)行相關(guān)性分析。3、比較心梗組PCI術(shù)后1周內(nèi)、術(shù)后3個(gè)月、術(shù)后6個(gè)月梗死相關(guān)節(jié)段的參數(shù)變化以。4、另選取10名志愿者（C組）同時(shí)（24小時(shí)內(nèi)）行RT-3DE、心臟磁共振（CMRI）檢查，采用線性回歸及Bland-Altman分析評(píng)價(jià)RT-3DE與CMRI所測EDV、ESV及EF值的相關(guān)性、一致性。 結(jié)果：1、Simpson法與RT-3DE測得A組EDV、ESV、EF值差別有顯著性（P＜0.05），B組EDV、ESV、EF值差別無顯著性（P＞0.05）。 2、A組梗死相關(guān)節(jié)段容積參數(shù)（rEDV、rESV）及左室收縮同步性參數(shù)（Tmsv-16-Dif、Tmsv-16-Dif%、Tmsv-16-SD、Tmsv-16-SD%）大于B組（P＜0.05），節(jié)段舒縮功能參數(shù)（rPER、rPFR、rEF）小于B組（P＜0.05)，A組EF與左室收縮同步性參數(shù)呈負(fù)相關(guān)。 3、A組梗死相關(guān)節(jié)段術(shù)后3個(gè)月時(shí)，節(jié)段容積及左室收縮同步性參數(shù)小于術(shù)后1周內(nèi)，節(jié)段舒縮功能參數(shù)大于術(shù)后1周內(nèi)（P＜0.05）；術(shù)后6個(gè)月上述參數(shù)與術(shù)后3個(gè)月相比差異不明顯（P＞0.05）。 4、冠脈血管開通時(shí)間小于6小時(shí)與大于6小時(shí)兩亞組比較：術(shù)后1周內(nèi)大于6小時(shí)組EDV、ESV較小于6小時(shí)組明顯增大（P＜0.05），而Tmsv-16-Dif%、Tmsv-16-SD%差異不明顯（P＞0.05）；術(shù)后3個(gè)月小于6小時(shí)組Tmsv-16-Dif%、Tmsv-16-SD%較前明顯減小（P＜0.05），而大于6小時(shí)組仍無明顯改變（P＞0.05）；術(shù)后6個(gè)月時(shí)兩亞組EDV、ESV、Tmsv-16-Dif%、Tmsv-16-SD%均小于術(shù)后1周內(nèi)（P＜0.05），且兩亞組間ESV、Tmsv-16-Dif%、Tmsv-16-SD%差別已不明顯（P＞0.05）。 5、RT-3DE測量左室容積與射血分?jǐn)?shù)與CMRI所測結(jié)果具有良好的一致性、相關(guān)性。 結(jié)論： 1.RT-3DE可準(zhǔn)確、詳細(xì)、定量評(píng)估AMI患者左室收縮、舒張功能及左室收縮同步性。 2.AMI患者左室發(fā)生了不同程度的重構(gòu)，RT-3DE能夠定量分析PCI治療術(shù)后這一變化，評(píng)價(jià)療效及預(yù)后。 3.RT-3DE與CMRI測值有良好的一致性與相關(guān)性。
[Abstract]:Objective: to quantitatively analyze left ventricular systolic and diastolic function and left ventricular systolic synchrony after PCI in patients with acute myocardial infarction (AMI) by real-time three-dimensional echocardiography (RT-3DE) and evaluate the changes of left ventricular remodeling. Methods: 2DE and RT-3DE were performed in 63 patients with acute myocardial infarction (group A) and 38 healthy subjects (group B) after PCI. Left ventricular systolic function: left ventricular end-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular ejection fraction (LVEF),) were compared between two groups. Group B: segmental contraction function (rEDV,rESV,rEF), segmental maximum ejection rate and maximum filling rate (rPER,rPFR). And left ventricular systolic synchrony: left ventricular maximum difference from 16 segments to minimum end-systolic volume time, standard deviation and the percentage of cardiac cycle (Tmsvl6-Dif,Tmsvl6-Dif%,Tmsvl6-SD,Tmsvl6-SD%), The differences of parameters between the two groups were compared, and the correlation between EF and left ventricular systolic synchrony parameters in myocardial infarction group was analyzed. 3. The parameters of infarct related segments in myocardial infarction group within 1 week, 3 months after operation and 6 months after operation were compared with those of myocardial infarction group in 1 week, 3 months and 6 months after operation. In addition, 10 volunteers (group C) were examined with RT-3DE, cardiac magnetic resonance (CMRI) simultaneously (within 24 hours). The correlation and consistency of RT-3DE with EDV,ESV and EF measured by CMRI were evaluated by linear regression and Bland-Altman analysis. Results: 1 there was no significant difference in EDV,ESV,EF between group A and group A (P < 0. 05) by), B method (P > 0. 05). 2Infarction related segmental volume parameters (rEDV,rESV) and left ventricular systolic synchronism (Tmsv-16-Dif,Tmsv-16-Dif%,Tmsv-16-SD,Tmsv-16-SD%) in group A were higher than those in group B (P < 0. 05). The segmental systolic and diastolic function parameters (rPER,rPFR,rEF) were significantly lower in group B than in group B (P < 0. 05). There was a negative correlation between EF and synchronism of left ventricular systolic parameters in group B (P < 0. 05). 3 at 3 months after operation, the segmental volume and left ventricular systolic synchronism in group A were less than those in 1 week after operation, and the systolic and diastolic function parameters were larger than those in 1 week after operation (P < 0.05). There was no significant difference in the above parameters between 6 months after operation and 3 months after operation (P > 0.05). 4. The opening time of coronary artery was less than 6 hours than that of more than 6 hours. The EDV,ESV of the more than 6 hours group was smaller than that of the 6 hours group (P < 0. 05), and the Tmsv-16-Dif%, was significantly higher than that of the 6 hour group (P < 0. 05). There was no significant difference in Tmsv-16-SD% (P > 0. 05). The Tmsv-16-Dif%,Tmsv-16-SD% of the group less than 6 hours after operation decreased significantly (P < 0. 05), but the group of more than 6 hours had no significant change (P > 0. 05). At 6 months after operation, the EDV,ESV,Tmsv-16-Dif%,Tmsv-16-SD% of the two subgroups was lower than that of the first week after operation (P < 0. 05), and there was no significant difference in ESV,Tmsv-16-Dif%,Tmsv-16-SD% between the two subgroups (P > 0. 05). The results of left ventricular volume and ejection fraction measured by RT-3DE were in good agreement with those measured by CMRI. Conclusion: 1.RT-3DE can accurately and quantitatively evaluate left ventricular systolic and diastolic function and left ventricular systolic synchrony in AMI patients. Left ventricular remodeling occurred in different degree in patients with 2.AMI. RT-3DE can quantitatively analyze the changes after PCI treatment and evaluate the curative effect and prognosis. There is good consistency and correlation between 3.RT-3DE and CMRI.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R542.22

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