本文選題：左室舒張功能 + 血管內(nèi)超聲(IVUS)�。� 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討冠心病患者左室舒張功能與血管內(nèi)超聲(IVUS)指導(dǎo)下的前降支近段病變狹窄程度的相關(guān)性。方法:入選標(biāo)準(zhǔn):穩(wěn)定型心絞痛和不穩(wěn)定型心絞痛患者且冠脈造影顯示為前降支單支病變。排除標(biāo)準(zhǔn):急性和陳舊性心肌梗死,射血分?jǐn)?shù)降低的心力衰竭,房顫,腎功能不全,心肌病,心臟瓣膜病,先心病,貧血,甲狀腺疾病,腫瘤,自身免疫性疾病,急性腦血管病,急性感染。所有穩(wěn)定型心絞痛和不穩(wěn)定型心絞痛準(zhǔn)備行冠脈造影檢查的患者入院后均常規(guī)行彩色多普勒超聲心動(dòng)圖檢查,分別測(cè)定左房?jī)?nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)、左心室射血分?jǐn)?shù)(LVEF)、E峰、A峰及E/A比值。根據(jù)冠脈造影結(jié)果,將有單支病變且為前降支近段病變需行IVUS檢查的患者納入研究。在行IVUS檢查過程中測(cè)量患者病變狹窄最嚴(yán)重部位最大管腔直徑(Max MLD)、最小管腔直徑(MLD)、管腔面積(LCSA)、中膜面積(EEM CSA)、斑塊負(fù)荷,并根據(jù)術(shù)中IVUS測(cè)量的病變狹窄程度將患者分為A組(最小管腔面積≥4.0mm2)和B組(最小管腔面積4.0mm2),分析兩組患者的臨床特點(diǎn)(年齡、高血壓、糖尿病病史、血脂等),比較兩組患者心臟超聲結(jié)果有無統(tǒng)計(jì)學(xué)差異。同時(shí)根據(jù)IVUS所測(cè)斑塊負(fù)荷數(shù)值將患者分為C組(斑塊負(fù)荷≥70%)和D組(斑塊負(fù)荷70%),分析兩組患者的臨床特點(diǎn)(年齡、高血壓、糖尿病病史、血脂等),比較兩組患者心臟超聲結(jié)果有無統(tǒng)計(jì)學(xué)差異,探討左室舒張功能不全與前降支近段病變狹窄程度的相關(guān)性。1選擇性冠狀動(dòng)脈造影由心內(nèi)科專業(yè)醫(yī)師操作,經(jīng)橈動(dòng)脈或股動(dòng)脈入路,Judkins法取多體位行冠狀動(dòng)脈造影,病變直徑狹窄比例≥50%為陽性病變,其中單支病變且為前降支近段病變需行IVUS檢查的患者納入研究。2 IVUS檢查應(yīng)用Boston Scientific公司的IVUS設(shè)備,探頭頻率為30MHz,以0.5mm/s速度回撤,選擇病變狹窄最嚴(yán)重處測(cè)量最大管腔直徑(Max MLD)、最小管腔直徑(MLD)、管腔面積(LCSA)、中膜面積(EEM CSA)及斑塊負(fù)荷。其中斑塊面積=EEM CSA-LCSA,斑塊負(fù)荷=斑塊面積/中膜面積×100%。3彩色多普勒超聲心動(dòng)圖檢查取患者胸骨旁左室長(zhǎng)軸切面測(cè)量左房?jī)?nèi)徑(LAD)、左室舒張末期內(nèi)徑(LVEDD)、左室收縮末期內(nèi)徑(LVESD),同時(shí)在此切面下,利用超聲儀改良Simpson’s法計(jì)算LVEDV、LVESV、左室射血分?jǐn)?shù)(LVEF);記錄舒張期經(jīng)二尖瓣口血流多普勒E峰(E),A峰(A)流速,E峰峰值速度與A峰峰值速度的比值(E/A)。上述指標(biāo)測(cè)量3個(gè)心動(dòng)周期,求其均值,所有超聲資料進(jìn)行存儲(chǔ)。為避免誤差,每個(gè)病人由專人按統(tǒng)一方法操作。結(jié)果:1 A組與B組比較,A組LAD(3.42±0.32cm)、LVEDD(4.75±0.34cm)、LVESD(3.01±0.46cm)均低于B組LAD(3.62±0.39cm)、LVEDD(5.00±0.51cm)、LVESD(3.30±0.56cm),兩者有統(tǒng)計(jì)學(xué)差異(P0.05),說明血管內(nèi)超聲測(cè)量的前降支近段病變的最小管腔面積≥4.0mm2和最小管腔面積4.0mm2比較,其左房?jī)?nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)有統(tǒng)計(jì)學(xué)差異。2 C組與D組比較,C組LAD(3.61±0.34cm)、LVEDD(5.02±0.55cm)、LVESD(3.33±0.65cm)均高于D組LAD(3.45±0.35)、LVEDD(4.79±0.34cm)、LVESD(3.05±0.34cm),兩者比較有統(tǒng)計(jì)學(xué)差異(P0.05),說明血管內(nèi)超聲測(cè)量的前降支近段病變的斑塊負(fù)荷≥70%和斑塊負(fù)荷70%比較,其左房?jī)?nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)有統(tǒng)計(jì)學(xué)差異。因左房?jī)?nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)已證明是代表左室舒張功能的指標(biāo),故A組與B組、C組與D組比較,其左室舒張功能有統(tǒng)計(jì)學(xué)差異。3 A組與B組、C組與D組比較,左室射血分?jǐn)?shù)(LVEF)、E峰、A峰及E/A比值均無顯著統(tǒng)計(jì)學(xué)差異(P值0.05)。這是因?yàn)樵诠谛牟』颊呤鎻埞δ懿蝗脑缙陔A段,E峰降低,A峰增高,E/A是降低的;隨著心力衰竭逐漸加重,E峰流速增高,E/A變?yōu)檎?當(dāng)心力衰竭更為嚴(yán)重時(shí),E峰增高,A峰降低,E/A比值增大。此研究中的各組冠心病患者處于舒張功能不全的不同時(shí)期,故E、A、E/A比值比較無顯著統(tǒng)計(jì)學(xué)差異。結(jié)論:無論是從IVUS測(cè)量的病變處最小面積角度還是從斑塊負(fù)荷角度比較,前降支近段病變與左室舒張功能有著良好的相關(guān)性。
[Abstract]:Objective: To investigate the correlation between left ventricular diastolic function and the degree of narrowing of anterior descending proximal diseased stenosis under the guidance of intravascular ultrasound (IVUS). Methods: criteria: stable angina and unstable angina pectoris and coronary angiography as a single branch of anterior descending branch. Acute and old myocardial infarction, ejection fraction Heart failure, atrial fibrillation, renal insufficiency, cardiomyopathy, valvular heart disease, congenital heart disease, anemia, thyroid disease, tumor, autoimmune disease, acute cerebrovascular disease, acute infection. All patients with stable angina and unstable angina pectoris were routinely treated with color Doppler echocardiography after admission to the hospital. The left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), E peak, A peak and E/A ratio were measured respectively. According to the results of coronary angiography, the patients with single branch lesion and the anterior descending proximal lesion needed IVUS examination were included in the study. The patients' lesions were measured during the procedure of IVUS examination. The maximum lumen diameter (Max MLD), the smallest lumen diameter (MLD), the area of the lumen (LCSA), the area of the middle membrane (EEM CSA), the plaque load, were divided into A group (minimum lumen area > 4.0mm2) and B group (4.0mm2 lumen area 4.0mm2) according to the degree of stenosis measured during the intraoperative IVUS. The clinical characteristics of the two groups were analyzed (age, high). Blood pressure, diabetes history, blood lipid, etc., compared to the two groups of patients with no statistical difference in echocardiographic results. According to the plaque load values of the IVUS group, the patients were divided into group C (plaque load > 70%) and group D (plaque load 70%), and the clinical characteristics of the two groups (age, hypertension, diabetes history, blood lipid, etc.) were analyzed, and the heart of the two groups was compared. There is no statistical difference between the results of ultrasound and the correlation between the left ventricular diastolic dysfunction and the degree of stenosis of the proximal descending branch of the anterior descending branch..1 selective coronary angiography is operated by a professional physician in the Department of Cardiology. Through the radial or femoral artery approach, the Judkins method takes the multiple position for coronary angiography, and the proportion of the diameter of the lesion is more than 50%. Patients with single lesion and anterior descending branch of the proximal segment requiring IVUS examination were included in the study of the.2 IVUS examination of the IVUS equipment of the Boston Scientific company, the probe frequency was 30MHz, the speed of 0.5mm/s was retraced, the maximum lumen diameter (Max MLD), the smallest lumen diameter (MLD), the lumen area (LCSA), and the area of middle membrane were measured. Plaque area (CSA) and plaque area =EEM CSA-LCSA, plaque load = patch area / medium membrane area * 100%.3 color Doppler echocardiography examination of left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and at the same time under this section, using a supersonic instrument. A good Simpson 's method was used to calculate LVEDV, LVESV, and left ventricular ejection fraction (LVEF), and the ratio of Doppler E peak (E), A peak (A) flow, E peak peak velocity to A peak velocity (E/A) was recorded during diastole. The above indexes were measured by 3 cardiac cycles, and all ultrasonic data were stored. Results: 1 A group was compared with group B, group A was LAD (3.42 + 0.32cm), LVEDD (4.75 + 0.34cm), LVESD (3.01 + 0.46cm) were lower than LAD (3.62 + 0.39cm) in B group, and (5 + 3.30), and there were statistical differences (3.30 +), and the minimum lumen area of the anterior descending proximal segment of the intravascular ultrasound measurement was more than equal and minimum. Compared with 4.0mm2, the left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were statistically different between.2 C group and D group, C group LAD (3.61 + 0.34cm), LVEDD (5.02 + 0.55cm), 3.45 + 0.35, 3.05 + 0.35. P0.05, indicating that the plaque load of the anterior descending proximal segment of the intravascular ultrasound was more than 70% and the plaque load 70%, the left atrium diameter (LAD), the left ventricular end diastolic diameter (LVEDD) and the left ventricular end systolic diameter (LVESD) were statistically different. The left atrial diameter (LAD), the left ventricular end diastolic diameter (LVEDD), and the left ventricular end systolic diameter (LVESD) had proved to be the generation. Compared with group B, group C and group D, the left ventricular diastolic function in group A and group C was statistically different from that in group.3 A and group B. There was no significant difference in left ventricular ejection fraction (LVEF), E peak, A peak and ratio between group C and D group (0.05). This is due to the reduction of peak peak in the early stage of diastolic dysfunction in coronary heart disease patients. The increase of E/A was reduced; with the gradual increase of heart failure, the flow rate of E peak increased and E/A changed to normal. When the heart failure was more serious, the E peak was increased, the A peak decreased, and the E/A ratio increased. There was no significant difference in the ratio of E, A and E/A in each group of coronary heart disease in this study. Conclusion: the ratio of E, A, and E/A was no significant difference. Conclusion: from I, no matter from I. The minimum area angle of lesion measured by VUS or compared with the plaque load angle, there is a good correlation between the proximal segment lesion and left ventricular diastolic function.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

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