目的探讨应用实时三维超声心动图(RT-3DE)评价急性心肌梗死患者经皮冠状动脉介入治疗(PCI)前后左心室局部功能变化的应用价值。方法选取2012年12月—2013年12月佳木斯大学附属第一医院接受PCI的急性心肌梗死患者46例为病例组,其中下后壁心肌梗死组27例,下壁心肌梗死组19例;另选择同时期体检中心体检健康者30例为对照组,对照组于体检时,病例组于PCI前、PCI后1、4、12周分别做RT-3DE检查,记录左心室各节段舒张末期容积(r EDV)及左心室各节段收缩末期容积(r ESV),并计算出各节段射血分数(r EF)。结果对照组RT-3DE左心室各节段容积-时间曲线规整有序,病例组患者PCI前RT-3DE左心室各节段容积-时间曲线杂乱无序。对照组与下后壁心肌梗死组PCI前及PCI后1周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF比较,差异有统计学意义(P<0.05);对照组与下后壁心肌梗死组PCI后4周下壁中间段、后壁中间段r EF比较,差异有统计学意义(P<0.05)。下后壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF比较,差异有统计学意义(P<0.05);其中PCI后1周后壁中间段r EF较PCI前升高(P<0.05);PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段、后壁基底段、后壁中间段r EF较PCI前及PCI后1周升高(P<0.05);PCI后12周下壁中间段、后壁中间段r EF较PCI后4周升高(P<0.05)。对照组与下壁心肌梗死组PCI前、PCI后1周及PCI后4周下壁基底段、下壁中间段、下壁心尖段r EF比较,差异有统计学意义(P<0.05)。下壁心肌梗死组患者PCI前、PCI后1周、PCI后4周及PCI后12周下壁基底段、下壁中间段、下壁心尖段r EF比较,差异有统计学意义(P<0.05);其中PCI后4周及PCI后12周下壁基底段、下壁心尖段r EF较PCI前及PCI后1周升高(P<0.05);PCI后12周下壁中间段r EF较PCI前及PCI后1周升高(P<0.05)。结论 RT-3DE可较准确反映急性心肌梗死患者PCI前后左心室局部收缩功能的变化,可作为评价PCI疗效的有效方法。 Objective To evaluate the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating the changes of left ventricular regional function in patients with acute myocardial infarction before and after percutaneous coronary intervention (PCI). Methods Forty-six patients with acute myocardial infarction who underwent PCI at the First Affiliated Hospital of Jiamusi University from December 2012 to December 2013 were selected as the case group, including 27 cases of inferior myocardial infarction and 19 cases of inferior myocardial infarction. At the same time, 30 cases of healthy people in the physical examination center were taken as the control group. At the time of physical examination in the control group, RT-3DE was performed before PCI and at 1, 4 and 12 weeks after PCI respectively. Diastolic volume r EDV) and left ventricular end systolic volume (r ESV), and calculate the ejection fraction (r EF) of each segment. Results In the control group, volume-time curves of each segment of the left ventricle in the control group were orderly and orderly. Volume-time curves of each segment of the left ventricle in the RT-3DE group before the PCI were disorderly and disorderly. The r EF of basal segment, middle segment of inferior wall, apical segment of inferior wall, basal segment of posterior wall and middle segment of posterior wall of control group and inferior posterior myocardial infarction group were significantly higher than those before PCI P <0.05). There was significant difference in r EF between the control group and the inferior posterior wall myocardial infarction group in the middle segment of the inferior wall and the middle segment of the posterior wall in the 4th week after PCI (P <0.05). Lower posterior wall myocardial infarction patients before PCI, PCI 1 week, PCI 4 weeks and PCI 12 weeks after the lower basal segment, the middle of the inferior wall, the inferior wall of the apical segment, the posterior wall of the basal segment, the middle of the posterior wall r EF (P <0.05). There was a significant increase of r EF in the middle wall of the middle wall after 1 week of PCI (P <0.05). At 4 weeks after PCI and 12 weeks after PCI, R EF of the middle segment of the inferior wall, the basal segment of the posterior wall and the middle segment of the posterior wall were significantly higher than those before PCI and 1 week after PCI (P <0.05) 4 weeks after PCI increased (P <0.05). There were significant differences in r EF between the control group and the inferior myocardial infarction group before PCI, 1 week after PCI and 4 weeks after PCI, and there was significant difference (P <0.05) between r EF of basal segment of inferior wall and middle segment of inferior wall. There were significant differences in r EF between the inferior myocardial infarction group before PCI, PCI 1 week, PCI 4 weeks and PCI 12 weeks after PCI (P <0.05) ). The r EF of the inferior basal segment and the inferior centrum of the inferior wall at 4 weeks after PCI and 12 weeks after PCI were higher than those before PCI and 1 week after PCI (P <0.05). The r EF of the lower middle wall at 12 weeks after PCI One week before PCI and one week after PCI (P <0.05). Conclusion RT-3DE can accurately reflect the changes of left ventricular regional systolic function before and after PCI in patients with acute myocardial infarction, and can be used as an effective method to evaluate the efficacy of PCI.