心肌致密化不全45例臨床分析
發(fā)布時(shí)間：2018-12-17 21:10
【摘要】：目的:探討心肌致密化不全(Noncompaction of Ventricular Myocardium,NVM)患者的臨床特點(diǎn)及超聲心動(dòng)圖診斷特點(diǎn),提高臨床醫(yī)生對(duì)心肌致密化不全患者的認(rèn)識(shí)和臨床診療水平,減少臨床誤診及漏診,早期發(fā)現(xiàn)、早期干預(yù)。方法:收集濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院自2103年1月至2014年12月超聲心動(dòng)圖符合心肌致密化不全診斷標(biāo)準(zhǔn)的45例住院患者病歷資料進(jìn)行回顧性分析,對(duì)心肌致密化不全患者的臨床特點(diǎn)及影像學(xué)特點(diǎn)進(jìn)行總結(jié),選取同期45例超聲心動(dòng)圖正常結(jié)果者作為對(duì)照組,與NVM患者超聲心動(dòng)圖左心室收縮功能指標(biāo)進(jìn)行分析比較,復(fù)習(xí)相關(guān)文獻(xiàn)展開(kāi)討論。結(jié)果:本研究中患者共45例,男20例,女25例,年齡8-73歲,平均58±15歲,男性占44.44%。心肌致密化不全患者以心力衰竭、心律失常及血栓栓塞為主要臨床表現(xiàn),45例患者表現(xiàn)為程度不等的心力衰竭,31例患者有心悸不適,1例有腦梗塞,1例患者有短暫腦缺血發(fā)作,1例患者因急性心肌梗死入院行心臟彩超檢查發(fā)現(xiàn)心肌致密化不全。40例患者胸片檢查,33例患者有不同程度心臟擴(kuò)大。所有患者均接受常規(guī)心電圖檢查,全部顯示出異常,其中有32例患者為ST-T改變,21例表現(xiàn)為室內(nèi)傳導(dǎo)阻滯,18例患者有室性心律失常,21例患者做24小時(shí)動(dòng)態(tài)心電圖檢查提示頻發(fā)室性早搏、室性早搏二聯(lián)律、短陣室性心動(dòng)過(guò)速。所有患者均通過(guò)超聲心動(dòng)圖檢查,達(dá)到心肌致密化不全超聲心動(dòng)圖診斷標(biāo)準(zhǔn),所有患者均見(jiàn)粗大的肌小梁及深陷的隱窩,形成網(wǎng)狀結(jié)構(gòu),隱窩間暗淡緩慢血流與心腔相通,病變心室壁分為2層,其中成人非致密化心肌與致密化心肌比值介于2.0-3.6之間,平均側(cè)壁為2.28±0.62,后壁2.33±0.73。有27例患者左室射血分?jǐn)?shù)小于30%,占60%,13例患者左室射血分?jǐn)?shù)處于30%-50%之間,占28.89%,5例射血分?jǐn)?shù)大于50%,占11.11%,其中合并二尖瓣返流43例,三尖瓣返流26例,心包積液16例,與正常對(duì)照組比較,年齡平均值接近,P=0.078,差異無(wú)統(tǒng)計(jì)學(xué)意義;反映左心室收縮功能的指標(biāo)包括左室舒張末期內(nèi)徑、左室射血分?jǐn)?shù)等進(jìn)行比較,P均小于0.01,差異有顯著統(tǒng)計(jì)學(xué)意義。其中作心臟磁共振(CMR)和心臟CT平掃加增強(qiáng)檢查的患者各1例,均符合NVM特征性改變。結(jié)論:心肌致密化不全臨床上少見(jiàn),發(fā)病率低,以進(jìn)行性加重的心力衰竭、多系統(tǒng)栓塞事件、各種心律失常為主要臨床表現(xiàn)。超聲心動(dòng)圖是最主要的檢查方法及確診手段,但在技術(shù)水平上有待進(jìn)一步探索提高,心臟磁共振檢查、心臟CT增強(qiáng)掃描在一定程度上對(duì)其起補(bǔ)充作用。藥物治療可以一定程度上改善患者癥狀。
[Abstract]:Objective: to investigate the clinical characteristics and echocardiographic diagnosis of myocardial compaction insufficiency (Noncompaction of Ventricular Myocardium,NVM) in order to improve the understanding and clinical diagnosis of the patients with myocardial compactness, and to reduce the misdiagnosis and missed diagnosis. Early detection, early intervention. Methods: the medical records of 45 inpatients who met the diagnostic criteria of myocardial compactness by echocardiography from January 2103 to December 2014 in affiliated Hospital of Jining Medical College were retrospectively analyzed. The clinical and imaging features of patients with myocardial compaction insufficiency were summarized. 45 patients with normal echocardiographic results were selected as control group and compared with patients with NVM on left ventricular systolic function. Review the relevant literature for discussion. Results: in this study, there were 45 patients (20 males and 25 females), aged 8-73 years (mean 58 鹵15 years). Heart failure, arrhythmia and thromboembolism were the main clinical manifestations in patients with myocardial compactness, 45 patients showed heart failure of varying degrees, 31 patients had palpitation and discomfort, and 1 patient had cerebral infarction. One patient had transient ischemic attack, one patient had myocardial compactness by color Doppler echocardiography, and 33 patients had heart dilatation in varying degrees. The results were as follows: 1 patient had transient ischemic attack, 1 patient had myocardial insufficiency by color Doppler echocardiography, 40 patients had chest radiography, and 33 patients had heart enlargement in varying degrees. All the patients were examined by routine electrocardiogram, all of them showed abnormal changes, including 32 patients with ST-T changes, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia. The 24-hour ambulatory electrocardiogram examination of 21 patients showed frequent ventricular premature beat, ventricular premature beat biphasic, short ventricular tachycardia. All the patients achieved the diagnostic criteria of myocardial densification insufficiency by echocardiography. All the patients showed thick trabeculae and deep recess, forming a reticular structure, and the dim blood flow between recesses communicating with the heart cavity. The ratio of nondensified myocardium to densified myocardium was between 2.0-3.6, the average lateral wall was 2.28 鹵0.62, and the posterior wall was 2.33 鹵0.73. The left ventricular ejection fraction (LVEF) was less than 30% in 27 patients, and the left ventricular ejection fraction was between 30% and 50% in 13 patients. The left ventricular ejection fraction (LVEF) was between 30% and 50% in 13 patients, and the ejection fraction was greater than 50 in 5 cases (11.11%) in which 43 cases were complicated with mitral regurgitation. There were 26 cases of tricuspid regurgitation and 16 cases of pericardial effusion. The indexes reflecting left ventricular systolic function included left ventricular end-diastolic diameter and left ventricular ejection fraction (P < 0.01). One case of cardiac magnetic resonance (CMR) and one case of cardiac CT were examined by plain scan and enhanced enhancement, all of them were in accordance with the characteristic changes of NVM. Conclusion: myocardial compaction insufficiency is rare in clinic and its incidence is low. The main clinical manifestations are heart failure with progressive exacerbation, multiple systemic embolism events and various arrhythmias. Echocardiography is the most important examination method and diagnostic method, but it needs to be further explored and improved on the technical level. Cardiac magnetic resonance examination and cardiac CT enhanced scan play a supplementary role to some extent. Drug therapy can improve the symptoms of patients to some extent.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R542.2
本文編號(hào)：2384802
[Abstract]:Objective: to investigate the clinical characteristics and echocardiographic diagnosis of myocardial compaction insufficiency (Noncompaction of Ventricular Myocardium,NVM) in order to improve the understanding and clinical diagnosis of the patients with myocardial compactness, and to reduce the misdiagnosis and missed diagnosis. Early detection, early intervention. Methods: the medical records of 45 inpatients who met the diagnostic criteria of myocardial compactness by echocardiography from January 2103 to December 2014 in affiliated Hospital of Jining Medical College were retrospectively analyzed. The clinical and imaging features of patients with myocardial compaction insufficiency were summarized. 45 patients with normal echocardiographic results were selected as control group and compared with patients with NVM on left ventricular systolic function. Review the relevant literature for discussion. Results: in this study, there were 45 patients (20 males and 25 females), aged 8-73 years (mean 58 鹵15 years). Heart failure, arrhythmia and thromboembolism were the main clinical manifestations in patients with myocardial compactness, 45 patients showed heart failure of varying degrees, 31 patients had palpitation and discomfort, and 1 patient had cerebral infarction. One patient had transient ischemic attack, one patient had myocardial compactness by color Doppler echocardiography, and 33 patients had heart dilatation in varying degrees. The results were as follows: 1 patient had transient ischemic attack, 1 patient had myocardial insufficiency by color Doppler echocardiography, 40 patients had chest radiography, and 33 patients had heart enlargement in varying degrees. All the patients were examined by routine electrocardiogram, all of them showed abnormal changes, including 32 patients with ST-T changes, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia, 21 patients with ventricular block, 18 patients with ventricular arrhythmia, 18 patients with ventricular arrhythmia. The 24-hour ambulatory electrocardiogram examination of 21 patients showed frequent ventricular premature beat, ventricular premature beat biphasic, short ventricular tachycardia. All the patients achieved the diagnostic criteria of myocardial densification insufficiency by echocardiography. All the patients showed thick trabeculae and deep recess, forming a reticular structure, and the dim blood flow between recesses communicating with the heart cavity. The ratio of nondensified myocardium to densified myocardium was between 2.0-3.6, the average lateral wall was 2.28 鹵0.62, and the posterior wall was 2.33 鹵0.73. The left ventricular ejection fraction (LVEF) was less than 30% in 27 patients, and the left ventricular ejection fraction was between 30% and 50% in 13 patients. The left ventricular ejection fraction (LVEF) was between 30% and 50% in 13 patients, and the ejection fraction was greater than 50 in 5 cases (11.11%) in which 43 cases were complicated with mitral regurgitation. There were 26 cases of tricuspid regurgitation and 16 cases of pericardial effusion. The indexes reflecting left ventricular systolic function included left ventricular end-diastolic diameter and left ventricular ejection fraction (P < 0.01). One case of cardiac magnetic resonance (CMR) and one case of cardiac CT were examined by plain scan and enhanced enhancement, all of them were in accordance with the characteristic changes of NVM. Conclusion: myocardial compaction insufficiency is rare in clinic and its incidence is low. The main clinical manifestations are heart failure with progressive exacerbation, multiple systemic embolism events and various arrhythmias. Echocardiography is the most important examination method and diagnostic method, but it needs to be further explored and improved on the technical level. Cardiac magnetic resonance examination and cardiac CT enhanced scan play a supplementary role to some extent. Drug therapy can improve the symptoms of patients to some extent.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R542.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 劉江澤;殷紅霞;陳海燕;羅麗;李華貴;;實(shí)時(shí)三維超聲心動(dòng)圖對(duì)心肌致密化不全的診斷價(jià)值[J];臨床超聲醫(yī)學(xué)雜志;2011年06期
，本文編號(hào)：2384802
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