本文選題：左束支傳導阻滯　切入點：冠心病　出處：《北京協(xié)和醫(yī)學院》2014年博士論文　論文類型：學位論文

【摘要】：第一部分心肌代謝18F-FDG PET顯像與心肌灌注99mTc-MIBI SPECT顯像在評價冠心病合并左束支傳導阻滯患者間隔灌注／代謝反向不匹配的研究 目的：左束支傳導阻滯影響左心室的心肌灌注,而左束支傳導阻滯對心肌代謝的影響尚未進行充分研究。因此本研究對冠心病合并左束支傳導阻滯患者的心肌灌注和代謝顯像進行研究。 方法：回顧性分析連續(xù)收集的65例疑診或確診冠心病合并左束支傳導阻滯患者,所有患者均行心肌代謝18F-FDG顯像和心肌灌注99mTc-MIBI顯像。所有患者均進行冠狀動脈造影和心臟超聲檢查。用左心室17節(jié)段劃分法分別對相應節(jié)段的心肌灌注、心肌代謝,以及超聲室壁運動進行評分。對所有患者以灌注正常、灌注減低、冠狀動脈造影結果、冠狀動脈供血區(qū)域以及灌注減低的不同程度分組評價心肌灌注和心肌代謝的關系,同時評價反向不匹配評分與心電圖QRS間期的關系,以及反向不匹配評分與超聲室壁運動評分的相關性。 結果：所有患者間隔的心肌灌注與心肌代謝的反向不匹配約占56.9%。在冠狀動脈造影正�；驔]有前降支病變的患者,間隔的反向不匹配是100%。在冠狀動脈造影前降支狹窄而前壁／間隔灌注正常的患者,間隔的反向不匹配是50%。在前降支狹窄而前壁／間隔灌注減低的患者,間隔的反向不匹配是54%。在心肌灌注正常的患者,間隔反向不匹配是82.8%,而在心肌灌注異常的患者間隔反向不匹配是36.1%。間隔反向不匹配比例在前降支供血區(qū)域高于回旋支和右冠狀動脈供血區(qū)域。間隔的反向不匹配在輕到中度灌注缺損患者是60%,而在重度灌注異常到缺損患者是6.25%。間隔的反向不匹配評分與QRS間期負相關(r=-0.371,p=0.005),而其余室壁的反向不匹配評分與QRS間期相關性無統(tǒng)計學的意義。各室壁的反向不匹配評分與超聲室壁運動評分相關性無統(tǒng)計學意義。 結論：在冠心病合并左束支傳導阻滯的患者,間隔灌注／代謝反向不匹配是其主要的特征。間隔反向不匹配評分與心電圖QRS間期呈負相關關系。 第二部分小型豬胸腔鏡下微創(chuàng)植入新型Ameroid環(huán)致慢性心肌缺血模型的實驗研究 目的：Ameroid縮窄環(huán)植入冠狀動脈后完全閉塞時間短,不利于形成冬眠心肌,模型均一性差。為了克服上述技術問題,本實驗提供了一種新型動脈縮窄環(huán),其能夠易于安放,且安放后對冠狀動脈影響小,且便于術后隨訪和觀察。為此,本實驗評價新型Ameroid縮窄環(huán)建立小型豬慢性心肌缺血模型的有效性。 方法：18只中華小型豬(25±5Kg)分為2組,新型Ameroid縮窄環(huán)組(n=12)和對照組(n=6)。實驗組通過微創(chuàng)胸腔鏡下左冠狀動脈回旋支植入新型Ameroid縮窄環(huán),對照組采用相同的方法只游離不套環(huán)。實驗組和對照組在術后4周行PET/CT及SPECT檢測心肌葡萄糖代謝以及心肌血流灌注情況,冠狀動脈造影檢測回旋支狹窄情況,心臟超聲在術前和術后4周檢測心功能。 結果：心臟超聲評價心功能變化,實驗組術前左心室舒張末期容積是31.9±6.7ml,術后4周為42.8±15.5ml。術后4周與術前相比,左心室舒張末期容積顯著增加(p0.05)。實驗組術前左心室收縮末期容積是8.8±2.8ml,術后4周左心室收縮末期容積是13.7±9.3ml(p=ns)。實驗組術前左心室每搏輸出量是23.9±7.0ml,實驗組術后4周左心室每搏輸出量是29.0±8.2ml(p=ns)。實驗組術前左心室射血分數為68.9±13.3%,術后4周左心室射血分數為69.8±9.0%(p=ns)。對照組術前左心室舒張末期容積是44.6±20.5ml,術后4周左心室舒張末期容積是36.3±6.5ml(p=ns)。對照組術前左心室收縮末期容積是10.2±1.9ml,術后4周左心室收縮末期容積是8.4±1.5ml(p=ns)。對照組左心室每搏輸出量術前是23.7±7.8ml,術后4周左心室每搏輸出量是27.9±5.6ml(p=ns)。左心室射血分數術前為69.0±5.8%,術后4周為76.7±3.9%(p=ns)。實驗組術后4周冠狀動脈造影顯示,冠狀動脈左回旋支狹窄程度為80±7.1%。術后4周心肌灌注顯像和心肌代謝顯像顯示,實驗組每只均有心肌存活,存活心肌的面積為9±4.8%。而對照組的心肌灌注顯像和心肌代謝顯像均正常。 結論：左冠狀動脈回旋支植入新型Ameroid縮窄環(huán),4周后心功能未見明顯改變,外側壁心肌血流灌注減低,而心肌代謝正常,表明心肌存活。推測新型Ameroid縮窄環(huán)可以成功建立慢性心肌缺血模型。
[Abstract]:The first part is myocardial metabolism 18F-FDG PET imaging and myocardial perfusion 99mTc-MIBI SPECT imaging in evaluating the interval perfusion / metabolic reverse mismatch between patients with coronary heart disease and left bundle branch block.
Objective: left bundle branch block affects left ventricular myocardial perfusion, while left bundle branch block has not yet fully studied the effect of left ventricular myocardial metabolism. Therefore, we studied myocardial perfusion and metabolic imaging in patients with coronary artery disease combined with left bundle branch block.
Methods: a retrospective analysis of 65 cases of suspected collected or confirmed coronary heart disease patients with left bundle branch block patients, all patients underwent 18F-FDG imaging of myocardial metabolism and myocardial perfusion 99mTc-MIBI imaging. All patients underwent coronary angiography and echocardiography. Left ventricular segment 17 division method of the corresponding segment of myocardial perfusion, myocardial metabolism, and ultrasonic wall motion score. All patients with normal perfusion, perfusion defect, coronary angiography results, evaluating the relationship between different degrees of myocardial perfusion and myocardial metabolism in coronary artery and regional perfusion reduced, at the same time the relationship between evaluation of reverse mismatch score and QRS interval of ECG, and reverse the matching score correlated with ultrasonic wall motion score.
Results: reverse myocardial perfusion and myocardial metabolism in all patients does not match the interval about 56.9%. patients without anterior descending coronary artery in normal or coronary angiography, interval reverse matching is 100%. in the anterior descending coronary artery angiography stenosis and wall / interval normal perfusion of patients, the reverse does not match the 50%. interval in the anterior descending artery wall / interval reduced perfusion of patients, the reverse does not match the 54%. interval in patients with normal myocardial perfusion, the interval does not match the reverse is 82.8%, and myocardial perfusion in patients with abnormal interval reverse mismatch is 36.1%. The reverse interval does not match the proportion in the anterior descending and circumflex blood supply area is higher than that of the right coronary artery. The interval of reverse mismatch in mild to moderate perfusion defect patients is 60%, while in the severe abnormal perfusion defect patients is to reverse 6.25%. interval does not match the score with QRS There was a negative correlation (r=-0.371, p=0.005), but there was no statistically significant correlation between the other side wall mismatch scores and QRS interval. There was no statistically significant correlation between the reverse mismatch scores and the wall motion score of each wall.
Conclusion: in patients with coronary artery disease complicated with left bundle branch block, interval perfusion / metabolic reverse mismatch is the main feature. There is a negative correlation between the interval reverse mismatch score and the QRS interval of ECG.
Experimental study on a new model of chronic myocardial ischemia induced by mini invasive implantation of a new type of Ameroid ring in second parts of miniature pigs
Objective: Ameroid constrictor implantation after coronary artery occlusion time is short, not conducive to the formation of hibernating myocardium, model uniformity. In order to overcome the technical problems, this experiment provides a new arterial constriction ring, which can be easily placed, and placed on the influence of coronary artery, and is convenient for postoperative follow-up and observation. Therefore, the evaluation of the new Ameroid shrink effective narrow ring to establish chronic myocardial ischemia model in pigs.
Methods: 18 pigs (25 + 5Kg) were divided into 2 groups, the new Ameroid constrictor group (n=12) and control group (n=6). The experimental group by Ameroid model of left circumflex coronary artery implantation of minimally invasive thoracoscopic constrictor and the control group by the same method. The experiment not only free ring group and control group at 4 weeks after operation of PET/CT and SPECT in detecting myocardial glucose metabolism and myocardial perfusion, coronary angiography detection of LCX stenosis, cardiac ultrasound in preoperative and postoperative 4 weeks to detect heart function.
緇撴灉錛氬績鑴忚秴澹拌瘎浠峰績鍔熻兘鍙樺寲,瀹為獙緇勬湳鍓嶅乏蹇冨鑸掑紶鏈湡瀹圭Н鏄，

本文編號：1568818