本文選題：急性心肌梗死 + 左心室功能��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景冠心病(CHD)是指在冠狀動脈的動脈粥樣硬化病變,動脈粥樣硬化的不斷發(fā)展會阻礙血液流動,造成局部慢性或急性缺血,冠狀動脈的粥樣硬化斑塊的形成是一個長期的過程,往往在早期即開始形成,當(dāng)血管受堵達(dá)到一定程度時則出現(xiàn)相應(yīng)的臨床表現(xiàn)。粥樣斑塊可導(dǎo)致患者在運(yùn)動、緊張或靜息狀態(tài)下的心絞痛癥狀、斑塊破裂導(dǎo)致急性血栓形成、猝死以及急性心肌梗死。在美國,超過1700萬人患有冠心病,近10萬人有心絞痛癥狀,至少有380000人因心肌梗死或與冠心病相關(guān)其他疾病猝死[1]。在我國,急性心肌梗死(AMI)已成為嚴(yán)重威脅生命健康的疾病之一[2]。急性心肌梗死血流重建的方式主要有三種,分別為:藥物溶栓治療、介入PCI術(shù)以及冠狀動脈旁路移植術(shù)。PCI術(shù)作為再灌注治療有效手段之一,能直接開通梗死相關(guān)動脈,恢復(fù)缺血心肌的血液供應(yīng),可以有效限制和縮小梗死面積,保護(hù)左心室的功能,改善病人的心室重構(gòu)和近期預(yù)后[3]。UCG在急性心肌梗死方面有極高預(yù)測價值,同時也可作為判斷PCI術(shù)后心臟功能改變的一個重要依據(jù)[4],從而廣泛應(yīng)用于AMI病人行PCI術(shù)后左室功能的評價。目的本課題通過對首發(fā)AMI患者行急診PCI術(shù),對患者術(shù)前、術(shù)后7天、2月分別進(jìn)行二維、四維超聲檢查,探討四維超聲心動圖評價AMI患者行急診PCI術(shù)后左室心功能改變的價值。方法選取2016年4月至10月收治入院的初發(fā)急性心肌梗死、并符合實(shí)驗(yàn)要求的50名患者入選病例組。排除既往有心肌梗死、心功能不全、惡性心律失常、糖尿病、腎功能衰竭等病史以及肥胖的患者。對入選病例組患者術(shù)前行二維、四維超聲心動圖檢查,并記錄2D-LVEDV、2D-LVESV、2D-LVEF、4D-LVEDV、4D-LVESV、4D-LVEF、GLS、GCS、GAS、GRS,為術(shù)前組;同一患者術(shù)后7天、2月均行二維、四維超聲心動圖檢查,記錄實(shí)驗(yàn)數(shù)據(jù),分別為術(shù)后7天、2個月組;急診PCI術(shù)后7天組,2個月組參數(shù)與術(shù)前組參數(shù)進(jìn)行統(tǒng)計學(xué)分析,4D-LVEF與心室應(yīng)變參數(shù)進(jìn)行相關(guān)性分析。結(jié)果(1)術(shù)后7天與術(shù)前相比,2D-LVEDV2D-LVESV及2D-LVEF的變化均無統(tǒng)計學(xué)意義(p0.05);術(shù)后2月與術(shù)后7天相比,2D-LVEDV及2D-LVEF的變化均無統(tǒng)計學(xué)意義(p0.05),2D-LVESV差異有統(tǒng)計學(xué)意義(p0.05);術(shù)后2月與術(shù)前相比,2D-LVEDV的變化無統(tǒng)計學(xué)意義(p0.05),2D-LVESV及2D-LVEF差異有統(tǒng)計學(xué)意義(p0.05)。(2)術(shù)后7天與術(shù)前相比,4D-LVEDV的變化無統(tǒng)計學(xué)意義(p0.05),4D-LVESV及4D-LVEF差異有統(tǒng)計學(xué)意義(p0.05);術(shù)后2月與術(shù)后7天相比,4D-LVEF的變化無統(tǒng)計學(xué)意義(p0.05),4D-LVEDV及4D-LVESV差異有統(tǒng)計學(xué)意義(p0.05);術(shù)后2月與術(shù)前相比,4D-LVEDV、4D-LVESV及4D-LVEF差異均有統(tǒng)計學(xué)意義(p0.05)。(3)術(shù)前即刻組、術(shù)后7天組與術(shù)后2月組相比,GLS、GCS、GRS及GAS數(shù)值均增大,只有GAS術(shù)后2月與術(shù)前差異有統(tǒng)計學(xué)意義(p0.05)。結(jié)論1.急性心肌梗死患者在行急診PCI術(shù)后,左心室功能較術(shù)前得到顯著改善。2.四維超聲心動圖在評價急性心肌梗死行急診PCI術(shù)術(shù)后左心室功能評價上有重要價值,且比二維超聲心動圖更早期、敏感、準(zhǔn)確的檢測出術(shù)后左室形態(tài)和功能的變化。3.臨床上,四維左心室整體射血分?jǐn)?shù)及心肌應(yīng)變能定量評價急性心肌梗死患者急診PCI術(shù)術(shù)前及術(shù)后的左心室功能,心肌應(yīng)變參數(shù)能全面、準(zhǔn)確、敏感地定量評價室壁心肌運(yùn)動的早期變化,其中四維應(yīng)變中整體面積應(yīng)變(GAS)在判斷左室心肌運(yùn)動減弱最敏感。
[Abstract]:Background coronary artery disease (CHD) refers to atherosclerotic lesions in the coronary arteries. The continuous development of atherosclerosis will impede blood flow and cause local chronic or acute ischemia. The formation of atherosclerotic plaque in coronary arteries is a long-term process, often in the early stages, when the blood vessel is blocked to a certain extent. Atherosclerotic plaque can lead to angina, acute thrombosis, sudden death, and acute myocardial infarction. In the United States, more than 17 million people suffer from coronary heart disease, nearly 100 thousand have angina, and at least 380000 are associated with myocardial infarction or coronary heart disease. Sudden death of other diseases ([1].) in China, acute myocardial infarction (AMI) has become one of the serious threats to life and health. There are three main ways of blood flow reconstruction in acute myocardial infarction: thrombolytic therapy, interventional PCI, and coronary artery bypass grafting (.PCI) as one of the effective means of reperfusion therapy, which can be directly opened. The infarct related artery and the recovery of the blood supply of the ischemic myocardium can effectively restrict and reduce the infarct size, protect the function of the left ventricle, improve the ventricular remodeling and the short-term prognosis of the patients with [3].UCG in the acute myocardial infarction, and can also be used as an important basis for judging the changes of cardiac function after PCI, thus, [4] The purpose of this study was to evaluate the left ventricular function of AMI patients after PCI. The purpose of this study was to evaluate the value of the left ventricular function change after the emergency PCI operation in the first AMI patients before the emergency PCI operation, and to evaluate the value of the left ventricular function after the emergency PCI operation in the first AMI patients. The value of the four dimensional echocardiography was evaluated before the operation and 7 days after the operation. In October, 50 patients with primary acute myocardial infarction were admitted to the hospital, which met the requirements of the experimental group. They excluded the history of myocardial infarction, cardiac insufficiency, malignant arrhythmia, diabetes, renal failure, and obese patients. Two dimensional, four dimensional echocardiography was performed before the operation of the selected case group, and the 2D-LVED was recorded. V, 2D-LVESV, 2D-LVEF, 4D-LVEDV, 4D-LVESV, 4D-LVEF, GLS, GCS, GAS, GRS, for the same patient 7 days after operation, 7 days, four dimensional echocardiography examination, record experimental data, 7 days after operation, 2 months group, 7 days after emergency PCI operation, 2 months group parameters and preoperative group parameters of statistical analysis, 4D-LVEF and ventricular strain parameters Results (1) the changes in 2D-LVEDV2D-LVESV and 2D-LVEF were not statistically significant (P0.05) at 7 days after operation, and there was no statistical significance (P0.05) in the changes of 2D-LVEDV and 2D-LVEF in February and 7 days after the operation, and the difference in 2D-LVESV was statistically significant (P0.05). The changes of 2D-LVEDV were not statistically significant in February after operation. The difference between 2D-LVESV and 2D-LVEF was statistically significant (P0.05). (2) there was no statistical significance (P0.05) in the changes of 4D-LVEDV (P0.05), and the difference between 4D-LVESV and 4D-LVEF (P0.05). There was no statistical significance (P0.05) in the changes of 4D-LVEF in February and 7 days after the operation (P0.05). There was a statistical difference between 4D-LVEDV and 4D-LVEF. Significance (P0.05); the difference in 4D-LVEDV, 4D-LVESV and 4D-LVEF in February after operation was statistically significant (P0.05). (3) the number of GLS, GCS, GRS and GAS increased in the immediate group before operation and in the 7 days after operation, compared with those in the group after the operation, only the difference between February and preoperative was statistically significant (P0.05). Conclusion 1. acute myocardial infarction patients were in emergency PCI. After operation, the left ventricular function was significantly improved by.2. four dimensional echocardiography in evaluating left ventricular function after emergency PCI operation in acute myocardial infarction, and the changes of left ventricular form and energy after operation were more early, sensitive and accurate than that of two dimensional echocardiography..3. The scores and myocardial strain energy can be used to evaluate the left ventricular function before and after the emergency PCI operation in acute myocardial infarction patients. The myocardial strain parameters can be used to evaluate the early changes of ventricular wall motion in a comprehensive, accurate and sensitive way, in which the overall area strain (GAS) in the four dimensional strain is the most sensitive to the left ventricular myocardial movement.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.22

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