【摘要】：背景 急性心肌梗死(acute myocardial infarction,AMI)是一種嚴(yán)重威脅人們身體健康的疾病,其中以前壁心肌梗死較常見。急性心肌梗死患者往往病情嚴(yán)重,預(yù)后較差,急性心肌梗死臨床上有多種治療方法,冠狀動(dòng)脈介入(Percutaneous Coronary Intervention,PCI)作為一種內(nèi)科有創(chuàng)性治療急性心肌梗死的方法,具有安全系數(shù)高、創(chuàng)傷性小、治療效果明顯等特點(diǎn),在臨床上較廣泛應(yīng)用。但如何快速和準(zhǔn)確地對PCI患者術(shù)后效果進(jìn)行評估,具有非常重要意義,目前心臟超聲技術(shù)是臨床最常用于檢測心室功能的技術(shù),已得到臨床醫(yī)生的一致認(rèn)可,具有無創(chuàng)、便宜、對病人要求低,準(zhǔn)確性高等特點(diǎn)。尤其近年來各種新超聲技術(shù)的廣泛應(yīng)用,使超聲檢查技術(shù)的準(zhǔn)確性進(jìn)一步提高,組織運(yùn)動(dòng)二尖瓣環(huán)位移測量(tracking of mitralanular displacement,TMAD)其在斑點(diǎn)追蹤技術(shù)理論基礎(chǔ)上進(jìn)行心功能指標(biāo)測量的新方法,TMAD技術(shù)通過斑點(diǎn)追蹤技術(shù)測量二尖瓣瓣環(huán)相對于左心室心尖部心肌長軸運(yùn)動(dòng),相對于傳統(tǒng)M型超聲具有較高時(shí)間分辨率,是對傳統(tǒng)心功能檢查方法缺點(diǎn)的彌補(bǔ),對檢測急性心急梗死患者心室功能早期改變具有重要意義。目的 評價(jià)二尖瓣環(huán)位移技術(shù)對急性前壁心肌梗死PCI術(shù)患者左心室收縮功能的診斷價(jià)值。材料與方法選擇2013年6月-2014年6月在淮南市第一人民醫(yī)院心血管內(nèi)科接受PCI手術(shù)的急性前壁心肌梗死患者作為研究組,另選取32例有相同合并癥及用藥史的冠心病患者作為對照組,使用飛利浦IE33彩色超聲診斷儀器,分別術(shù)前1周內(nèi)、術(shù)后2個(gè)月均采用Simpson方法測定左心室射血分?jǐn)?shù)(LVEF).另選取心尖四腔心、兩腔心及左室長軸兩腔心,應(yīng)用機(jī)器自帶軟件Qlab6.0軟件進(jìn)行組織運(yùn)動(dòng)二尖瓣瓣環(huán)位移測量(TMAD)及二尖瓣環(huán)的收縮期平均位移峰值(Ds)測量,并進(jìn)行數(shù)據(jù)分析研究。運(yùn)用SPSS16.0統(tǒng)計(jì)軟件分析PCI手術(shù)前后AMI患者的TMAD及Ds數(shù)據(jù),來評估左心室收縮功能的變化,同時(shí)應(yīng)用Person直線相關(guān)性來檢驗(yàn)TMAD及Ds數(shù)據(jù)與LVEF的相關(guān)性,并繪制散點(diǎn)圖。結(jié)果1.AMI手術(shù)后組LVEF較AIM手術(shù)后組結(jié)果有所提高,但p0.05,差異不具有統(tǒng)計(jì)學(xué)意義,AMI手術(shù)后組LVESV較AMI手術(shù)前組有所改善,p0.05差異具有統(tǒng)計(jì)學(xué)意義。2.AMI手術(shù)前組、手術(shù)后組TMAD參數(shù)比較,AMI手術(shù)后組TMAD參數(shù)較手術(shù)前明顯升高,尤其TMADmidpt%較為明顯,p0.01,差異具有顯著統(tǒng)計(jì)學(xué)意義。3.AMI手術(shù)后組Ds與AMI手術(shù)前組Ds數(shù)據(jù)比較明顯提高,p0.05,差異具有統(tǒng)計(jì)學(xué)意義；AMI手術(shù)前組Ds參數(shù)較對照組二尖瓣環(huán)Ds明顯減低,p0.01,差異具有明顯統(tǒng)計(jì)學(xué)的意義。4.AMI手術(shù)前、手術(shù)后組TMAD參數(shù)與LVEF均存在顯著的正相關(guān)性,AMI手術(shù)前、后組二尖瓣環(huán)6個(gè)位點(diǎn)平均Ds與LVEF亦呈正相關(guān)性(p均為0.000)。結(jié)論TMAD技術(shù)評價(jià)急性前壁心急梗死PCI術(shù)患者左心室收縮功能的早期改變較辛普森法測定的左室射血分?jǐn)?shù)更敏感。
[Abstract]:Background Acute Myocardial Infarction (acute myocardial infarction,AMI) is a serious threat to people's health. Patients with acute myocardial infarction often have a serious condition and poor prognosis. There are many kinds of treatment methods in acute myocardial infarction. Coronary intervention (Percutaneous Coronary Intervention,PCI) is a kind of internal invasive treatment for acute myocardial infarction. It is widely used in clinic because of its high safety factor, small trauma and obvious therapeutic effect. However, it is of great significance to evaluate the postoperative results of PCI patients quickly and accurately. At present, echocardiography is the most commonly used technique to detect ventricular function in clinic, which has been unanimously recognized by clinicians, and is noninvasive and inexpensive. Low demand for patients, high accuracy and other characteristics. Especially in recent years, with the wide application of various new ultrasound techniques, the accuracy of ultrasonic examination technique has been further improved. Tissue motion mitral annulus displacement measurement (tracking of mitralanular displacement, TMAD) is a new method to measure cardiac function index based on dot-tracing technique. TMAD technique is used to measure mitral annular movement relative to left ventricular apical myocardial long axis. Compared with the traditional M-mode ultrasound, it has higher time resolution, which is a remedy for the shortcomings of the traditional cardiac function examination method, and it is of great significance to detect the early changes of ventricular function in patients with acute myocardial infarction. Objective to evaluate the value of mitral annular displacement in the diagnosis of left ventricular systolic function in PCI patients with acute anterior myocardial infarction. Materials and methods patients with acute anterior myocardial infarction underwent PCI operation in Department of Cardiovascular Medicine, first people's Hospital of Huainan City from June 2013 to June 2014, were selected as the study group. Another 32 patients with coronary heart disease with the same complication and history of medication were selected as control group. The left ventricular ejection fraction (LVEF).) was measured by Simpson method within 1 week before operation and 2 months after operation using Philips IE33 color ultrasound diagnostic apparatus. In addition, the apical four-chamber heart, two-chamber heart and left ventricular long-axis two-chamber heart were selected to measure the mitral annular displacement by using the software Qlab6.0 software. The mitral annular displacement was measured by (TMAD) and (Ds). And carries on the data analysis research. The TMAD and Ds data of AMI patients before and after PCI operation were analyzed by SPSS16.0 software to evaluate the changes of left ventricular systolic function. The correlation between TMAD and Ds data and LVEF was examined by Person linear correlation. Results the results of LVEF in 1.AMI group were higher than those in AIM group, but the difference was not statistically significant (p 0.05). The LVESV of AMI group was better than that of AMI group after AMI operation, and the difference was statistically significant before 2.AMI operation. The TMAD parameters of AMI group were significantly higher than those of pre-operation group, especially TMADmidpt%, p0.01, the difference was statistically significant. The Ds data of 3.AMI group and AMI group were significantly higher than that of AMI group. P0.05, the difference was statistically significant. The Ds of mitral annulus in AMI group was significantly lower than that in control group (p 0.01). Before and after 4.AMI operation, there was a significant positive correlation between TMAD parameters and LVEF, and before AMI operation, there was a significant positive correlation between TMAD parameters and LVEF. There was also a positive correlation between the mean Ds and LVEF at 6 sites of mitral annulus in the posterior group (p = 0.000). Conclusion TMAD is more sensitive than Simpson method in evaluating the early changes of left ventricular systolic function in patients with acute anterior wall acute infarction (PCI).
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2

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