【摘要】 目的探讨急性心肌梗死(AMI)伴心力衰竭患者,行主动脉内球囊反搏泵植入(IABP)术后的床旁数字化X线摄影(DR)诊断价值与临床意义。方法收集我院2017年1月至2018年12月收治的56例AMI伴心力衰竭患者的临床资料进行回顾性分析。通过观察手术当天与术后3～5 d床旁DR片评价心影大小、肺血管变化、导管头位置,同时结合观察患者治疗后实验室检查及临床疗效、超声心动图指标变化评价床旁DR片对AMI伴心力衰竭患者IABP术后的效果。结果 56例患者行IABP术后当天床旁DR检查均见两肺纹理增多、增粗且边缘模糊,两上肺静脉影扩张、两肺门影增浓,提示两肺淤血征象。7例出现Kerley B线,提示两肺间质性肺水肿,3例患者出现两肺内中带对称分布大片状阴影,两肺门影增浓,提示两肺泡性肺水肿。心缘丰满、心膈面延长56例,其中以左心房及左心室增大为主51例,左、右心房及左、右心室增大5例,少量胸腔积液45例。46例患者IABP术后3 d复查可见两肺淤血及双侧胸腔积液均明显吸收,心影较前缩小同时超声心动图射血分数(EF)值较前升高且>50%。9例患者IABP术后3 d复查两肺水肿较前有所吸收,术后5 d复查,两肺水肿及双侧胸腔积液较前明显吸收,同时超声心动图EF值>50%。2例患者肺水肿合并两肺感染,治疗5 d后复查胸部X线片仍未见明显改变。其中9例患者复查发现导管头端靠下,2例术后复查导管头端靠上,经过二次调整后全部在位。结论床旁DR片是AMI伴心力衰竭患者行IABP术后效果评价的一个不容忽视的检查手段,具有较高的临床应用价值。更多还原

【Abstract】 Objective To explore the diagnostic value and clinical significance of bedside digital radiography(DR) after intra aortic balloon counter pulsation(IABP) implantation in patients with acute myocardial infarction(AMI) and heart failure(HF). Methods The clinical data of 56 patients with AMI and HF in our hospital were retrospectively analyzed. Preoperative patients bedside DR with IABP after implantation treatment bed DR review and contrast,through the observation of postoperative and preoperative bed DR heart shadow size,pulmonary blood change,conductor head position,at the same time,combined with the observation of patients after treatment efficacy,echocardiography index change bed DR for acute myocardial infarction in patients with heart failure with aortic balloon counterpulsation effect evaluation of the effect after implantation.Results Both pulmonary veins were dilated,the veins of pulmonary vessels were increased and thickened,the edges were blurred,and the hilum of the lungs went straight to the outer part of the upper lungs. Gram B line was observed in 7 patients,indicating interstitial pulmonary edema; "sphenoid sign" was observed in 3 patients,indicating alveolar pulmonary edema;cardiac shadow enlargement was observed in 56 patients,including 51 cases of enlargement from left atrium and left ventricle,5 cases of general enlargement of whole heart,and 45 cases of small amount of pleural effusion. Two pulmonary congestion and bilateral pleural effusion in 46 patients were significantly absorbed 3 days after IABP operation,and the cardiac shadow was reduced compared with that before. In 9 patients,bilateral pulmonary edema was absorbed compared with that before IABP operation,and bilateral pulmonary edema and bilateral pleural effusion were significantly absorbed compared with that before IABP operation. Two patients were treated with pulmonary edema combined with infection of both lungs. Chest radiographs showed no significant changes after 5 days of treatment. Catheter tips were found to be lower in 9 patients during review, and catheter tips were found to be higher in 2 patients after review. Conclusion Bedside DR tablet is a non-negligible examination method to evaluate the effect of intra-aortic balloon contractile implantation in patients with AMI and HF, and has high clinical application value.更多还原