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目的:探讨实时三维超声心动图对急性心肌梗死患者接受再灌注治疗后左室重构的诊断价值。方法:首次急性心肌梗死接受直接经皮冠状动脉介入治疗(P-PCI)或溶栓治疗患者共53例,比较治疗前及P-PCI治疗后1h、溶栓治疗后2h的心电图上ST抬高段的总和。按ST段下降幅度分为两组:ST段下降≥50%(A组n=32);ST段下降<50%(B组n=21)。于治疗后2d、10d、90d时行M型超声心动图和实时三维超声心动图(RT3DE)检查,分别测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、治疗后90d时LVEDV增大率作为反映左室结构和功能变化的指标,并比较M型超声心动图和RT3DE结果。结果:无论是M型超声心动图还是RT3DE,A组治疗后90d时与治疗后2d相比,LV-EDV、LVESV明显减小,LVEF明显增大(P<0.05);10d时变化不明显(P>0.05)。B组治疗后10d、90d与治疗后2d相比,LVEDV、LVESV均明显增大,LVEF均明显减小。M型超声心动图所测数值均大于RT3DE测值(P<0.05);对于B组,治疗后90d时M型超声心动图所测LVEDV增大率明显大于RT3DE测值(P<0.05)。结论:相比于M型超声心动图,应用RT3DE可更准确地评价急性心肌梗死后左室重构的动态改变;应用M型超声心动图会高估左室重构程度。
Objective: To investigate the diagnostic value of real-time three-dimensional echocardiography in left ventricular remodeling in patients with acute myocardial infarction after reperfusion. Methods: A total of 53 patients undergoing primary percutaneous coronary intervention (P-PCI) or thrombolysis in the first AMI were enrolled in this study. Before treatment and 1 h after P-PCI, ST elevation on the electrocardiogram was observed 2 h after thrombolysis The sum of the segments. Divided by ST-segment decline into two groups: ST-segment decreased ≥ 50% (A group n = 32); ST-segment decreased by <50% (B group n = 21). The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEDV) were measured by M-mode echocardiography and real-time three dimensional echocardiography (RT3DE) Score (LVEF), LVEDV enlargement 90 days after treatment as an indicator of left ventricular structural and functional changes, and compared M-mode echocardiography and RT3DE results. Results: LV-EDV and LVESV were significantly decreased and LVEF were significantly increased (P <0.05) at 90 days after treatment in group A compared with those at 2 days after treatment. The changes were not significant at 10 days P> 0.05). In group B, LVEDV and LVESV were significantly increased and LVEF were significantly decreased at 10 and 90 days after treatment compared with 2 days after treatment. The values measured by M-mode echocardiography were all higher than those by RT3DE (P <0.05). For group B, the increase rate of LVEDV measured by M-mode echocardiography was significantly greater than that of RT3DE at 90 days after treatment (P <0.05). CONCLUSIONS: Compared with M-mode echocardiography, RT3DE can be used to evaluate the dynamic changes of left ventricular remodeling more accurately. M-mode echocardiography can overestimate the extent of left ventricular remodeling.