左心声学造影对STEMI病人PCI术后心肌灌注及预后的评估价值

目的 探讨心肌声学造影(MCE)对急性STEMI病人PCI术后评估心肌灌注及预后的价值。方法 纳入本院78例急性STEMI且行PCI手术患者的病例资料,且术后48h均行MCE,根据MCE结果分为A组(灌注充盈正常：心肌节段造影剂充盈均匀,完全显影)43例,B组(灌注充盈稀疏：心肌节段造影剂充盈不均匀或部分显影)20例,C组(灌注充盈缺损：心肌节段造影剂充盈缺损,完全不显影)15例。应用常规超声与MCE技术获取各组患者术后48h、1个月、3个月左心功能指标左室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)]。记录三组患者术后6个月、12个月、24个月的主要不良心血管事件(MACE)发生率,并应用Logistic向后逐步回归分析急性STEMI患者PCI术后发生MACE的独立危险因素。结果 与A组比较,B、C组LVEDV、LVESV均较高,Am、E、LVEF较低,差异均有统计学意义(均P＜0.05)。与B组比较,C组LVEDV、LVESV均较高,Am、E、LVEF较低,差异均有统计学意义(均P＜0.05)。与A组比较,B、C组PCI术后MACE发生率较高,差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果显示,LVEDV、LVESV、LVEF、MCE结果均为影响急性STEMI患者PCI术后发生MACE的独立危险因素(P＜0.05)。结论 MCE可有效评估急性STEMI患者PCI术后心肌灌注情况,可独立预测术后MACE事件的发生,利于患者预后。

Evaluation value of myocardial contrast echocardiography for myocardial perfusion and prognosis in STEMI patients after PCI

Objective To explore the evaluation value of myocardial contrast echocardiography (MCE) for myocardial perfusion and prognosis in patients with acute STEMI after PCI. Methods The case data of 78 patients with acute STEMI undergoing PCI in the hospital were collected. All underwent MCE within 48h after surgery. According to MCE results, they were divided into group A (43 cases, normal perfusion filling: contrast agents filling in myocardial segments were even, complete developing), group B (20 cases, sparse perfusion filling: contrast agents filling in myocardial segments were uneven, partial developing) and group C (15 cases, defected perfusion filling: contrast agents filling in myocardial segments were defected, complete non-developing). The left ventricular function indexes left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume ( LVESV)] in different groups were obtained by routine ultrasound and MCE at 48h, 1 month and 3 months after surgery. The incidence of major adverse cardiovascular events (MACE) in the three groups was recorded at 6, 12 and 24 months after surgery. The independent risk factors of MACE were analyzed by Logistic backward stepwise regression analysis. Results Compared with group A, LVEDV and LVESV were increased, while LVEF was decreased in groups B and C (P<0.05). Compared with group B, LVEDV and LVESV were increased, while LVEF was decreased in group C (P<0.05). Compared with group A, incidence of MACE after PCI was higher in groups B and C (P<0.05). The results of multivariate Logistic regression analysis showed that LVEDV, LVESV, LVEF and MCE results were independent risk factors of MACE in patients with acute STEMI after PCI (P<0.05). Conclusion MCE can effectively evaluate myocardial perfusion and independently predict the occurrence of postoperative MACE in patients with acute STEMI after PCI, which is conducive to prognosis of patients.