【作者】 沈斌；

【导师】 吾柏铭；

【作者基本信息】 苏州大学 ， 心血管内科， 2001， 硕士

【摘要】 目的：1．观测比较正常室壁心肌和梗塞心肌的运动特征；2．评估多普勒组织成像(DTI)并对比二维(2D)超声心动图对冠心病梗塞心肌的诊断价值。 方法：心肌梗塞患者46例，其中前间壁梗塞组29例和下后壁梗塞组17例，健康人48例作对照，分别行2D超声检查，在6个切面(ap4cv、ap2cv、alax、pslax、pssax(CT)、pssax(PM))上按左室壁16节段分段法观测局部室壁心肌运动并记录运动异常节段，在alax上测量室壁节段厚度；在每一切面上切换为DTI速度图，观察比较正常心肌运动与梗塞心肌运动的色彩变化和频谱曲线形态特征，测量计算各室壁节段心肌运动的PW-DTI速度指标(S_m、E_m、PVG_s、PVG_e、MVG_s、MVG_e)，并分别作组间和组内比较。对PW-DTI与2D超声检测梗塞和缺血心肌的诊断结果作相互比较。 结果：1．DTI速度图显示，①健康人室壁心肌运动色彩均匀、鲜亮，同一室壁各节段内膜下心肌相同方向运动速度由基底段至心尖段逐渐降低。②梗塞心肌运动色彩较暗，频谱曲线S波低矮或紊乱。2．PW-DTI速度数值显示，①健康人室壁心肌同一方向运动速度，室间隔、前壁和前间隔分别低于侧壁、下壁和后壁；室壁内膜下心肌运动速度大于外膜下心肌运动速度，差别均十分显著(p＜0.01或p＜0.05)。②心肌梗塞患者各室壁节段运动速度无论长、短轴方向均较正常低，多数室壁节段差别达显著(p＜0.01或p＜0.05)，但不同室壁心肌因与梗塞相关与否而运动速度变化有差异，即，长轴方向，前间壁梗塞患者前间隔肌层间运动速度差别消失，差异不显著(P＞0.05)，而后壁肌层间运动速度则仍存在显著差别(p＜0.01)并较健康人肌层间运动速度的差别显著升高(p＜0.05)；下后壁梗塞患者下壁(长轴方向)、后壁(短轴方向)运动速度较健康人降低的程度分别比前壁、前间隔更显著(p＜0.01或p＜0.05)。3．除心尖段室壁外，PW-DTI检测心梗患者室壁运动异常节段的检出率大于等于2D 多普勒组织成像速度图定量检测左室壁心肌运动的研究 摘要 超声，其检测梗塞和缺血心肌的准确性、敏感性高于ZD超声，敏o 感性差别显著一叼刀5人 其特异性低于ZD超声，差别也显著 中邻刀5人4．＊＊Dn检测心肌运动速度的重复性，在检查者之间 和检查者两次检测均较佳。 结论：l、DTI是检测心肌运动速度简易、准确、定量、无创和 便于重复的新技术。入 正常室壁心肌运动具有同步向心牲收缩的特 征；梗塞心肌运动失去正常的同步运动特征，运动速度较正常明显 降低：＊n能够分辨这种运动异常。3、＊n诊断冠心病心肌梗塞 优于ZD超声。更多还原

【Abstract】 OBJECTIVES. This study was performed to observe and measure the movement of ventricular wall in patients with myocardial infarction comparing with that of normal ventricular wall and to evaluate the diagnostic value of Doppler tissue imaging(DTI) for detection of myocardium in myocardial infarction comparing with that of two-dimensional(2D) echocardiography.METHODS. The left ventricular wall motion of 46 patients with myocardial infarction(anterior-septum group in 29, inferior-posterior group in 17) and 48 HEALTH was assessed. In six views(ap4cv,ap2cv,alax,pslax,pssax(CT), pssax(PM)), The regional left ventricular wall motion was observed by 2D echocardiography according to 16 segments and abnormal movement was recorded. The thickness of myocardial segments was measured in alax. Having switched to DTI in each view, the color coded by DTI of ventricular wall motion and the form of spectrum curve of ventricular wall motion in myocardial infarction were observed and compared with those of normal myocardium. The markers(Sm, Em, PVGS, PVGe, MVGS, MVGe) of pulsed wave-DTI(PW-DTI) of segments were measured or calculated and each of them was compared in infra-group and intra-group. The diagnostic result of PW-DTI for detection of myocardium in myocardial infarction and myocardium in myocardial ischemia was compared with that of 2D echocardiography.RESULTS. 1. ㏕he color coded by DTI of ventricular wall motion was well-distributed and bright in HEALTH and endocardial velocities of the same ventricular wall which were in the same direction decreased gradually along cardiac base to cardiac apex. (2) At myocardium in myocardial infarction, the color coded by DTI of ventricular wall motionwas faint relatively and the amplitude of S wave was lower and the form of S wave was chaotic. 2. ㊣n the same direction, myocardial velocity of interventricular septum , anterior wall, anteroseptal wall was respectively smaller than that of lateral wall, inferior wall, posterior wall and endocardial velocity was larger than epicardial velocity. All above-mentioned differences were extremely significant(p<0.01 or p<0.05). (2) No matter long-axis or short-axis, all velocities of segments in patients with myocardial infarction were smaller than those in HEALTH and the majority of differences was significant(p<0.01 or p<0.05).However, there were differences of velocity variety existed between ventricular wall in myocardial infarction and normal ventricular wall. In the direction of long-axis, the velocity difference between anteroseptal endocardium and anteroseptal epicardium was not significant(p>0.05) in patients with anterior-septum myocardial infarction and the velocity difference between posterior endocardium and posterior epicardium was still significant(p<0.05) and larger significantly than that of HEALTH(p<0.05). In patients with inferior-posterior myocardial infarction, the decreasing degree of velocity in inferior wall(long-axis) and in posterior wall(short-axis) was respectively more significant than that in anterior wall and in anteroseptal wall(p<0.01 or p<0.05). 3. Except for cardiac apex, the positive rate of PW-DTI for detection of segments whose ventricular wall motion was abnormal was larger than or equal to that of 2D echocardiography. The accuracy and sensibility of PW-DTI for detection of myocardium in myocardial infarction and myocardium in myocardial ischemia were all larger than those of 2D echocardiography and the specificity of PW-DTI for detection of myocardium in myocardial infarction and myocardium in myocardial ischemia was smaller than that of 2D echocardiography. The difference of sensibility and of specificity was respectively significant between PW-DTI and 2Dechocardiography(p<0.05). 4. The repetition of PW-DTI for detection of myocardial velocity was better among infra-examiner and within intra-examiner.CONCLUSIONS. 1. DTI is a new technigue by which operation is simple and non-invasive and by which detection is accurate > quantitative and easy to repeat. 2. The feature of normal更多还原