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目的探讨急诊床边超声心动图对急性心肌梗死(AM I)室壁穿孔的诊断价值。方法彩色多普勒诊断仪床边直接探测AM I患者16例,测量各房室腔大小、各节段室壁厚度及运动情况、室壁瘤范围及瘤壁厚度,重点观察室间隔穿孔的位置及大小、穿孔周围心肌回声情况以及彩色多普勒血流状态。结果穿孔位于室间隔较为多见(11例),穿孔部位心肌明显变薄、向右室隆凸,在穿孔部位可见由左室经穿孔处入右室的收缩期五彩血流束,伴有不同程度心包积液。局部心肌收缩速度明显减低,其余节段心肌代偿性增强。结论对AM I患者临床上发现突然出现心脏杂音及临床症状并突然恶化应及早进行急诊床边超声心动图检查,以作出早期室壁穿孔的正确诊断,为临床内外科治疗提供可靠依据。
Objective To investigate the diagnostic value of emergency bedside echocardiography in the diagnosis of ventricular perforation in acute myocardial infarction (AMI). Methods 16 cases of AMI patients were directly detected by bedside color Doppler sonography. The size of each chamber, the thickness and movement of each segment, the extent of aneurysm and the thickness of aneurysm were measured. The location of perforation And size, perforated myocardial echo around the situation and color Doppler flow status. Results perforation in the more common ventricular septum (11 cases), perforation of the myocardium was significantly thinned, right ventricular bulge in the perforation site can be seen from the left ventricular perforation into the right ventricular systolic flow of colorful bloodstream, with different Degree of pericardial effusion. Local myocardial contraction rate was significantly reduced, the rest of the segmental myocardial compensatory enhancement. Conclusion The clinical diagnosis of AMI patients with sudden onset of heart murmur and clinical symptoms and sudden deterioration should be carried out early emergency bedside echocardiography to make the correct diagnosis of early ventricular perforation for the clinical surgical treatment to provide a reliable basis.