RT-3DE评价急性心肌梗死患者左心室局部功能变化的价值分析

目的:探讨应用实时三维心脏彩超(RT-3DE)评价急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)治疗前后左心室局部功能变化的作用。方法:选择PCI治疗的AMI患者21例为PCI组,选择相同年龄段慢性稳定性冠心病患者和健康体检者各20例,作为冠心病组和对照组。比较3组治疗前、后RT-3DE时间-容积曲线、左心室整体和局部功能指标的差异。结果:PCI组术前时间-容积形态最为不规则,术后原有紊乱节段改善明显。PCI组术前左室舒张末容积(LVEDV)和左室收缩末容积(LVESV)显著高于对照组和冠心病组,左室射血分数(LVEF)显著低于对照组和冠心病组,PCI术后上述指标均得到明显改善。PCI组左室前壁和前间壁的术前局部舒张末容积(REDV)和局部收缩末容积(RESV)显著高于对照组和冠心病组,局部射血分数(REF)和局部整体射血分数(RGEF)显著低于对照组和冠心病组,术后上述指标均得到明显改善。结论:RT-3DE可以直观、细致地评价AMI患者左心室局部功能变化。     

择期PCI对急性心肌梗死患者心功能的影响

目的观察择期经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心功能的影响。方法选择KillipⅠ~Ⅲ级AMI住院患者68例,AMI后10~14 d行冠状动脉造影证实梗死相关动脉(IRA)完全闭塞,依据是否行PCI将入选患者分为PCI组和对照组,并在住院和随访期间行C反应蛋白(CRP)、脑钠素(BNP)及超声心动图检查,测量两组术后1个月、6个月左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI),测定两组AMI后7 d及6个月时CRP及BNP水平。结果 AMI后1个月,两组各项心功能参数无显著差异(P0.05),6个月时成功PCI组LVEF、LVESVI、LVEDVI明显改善(P0.05),而对照组心功能下降,两组间差异有统计学意义(P0.05),治疗6个月后,PCI组CRP、BNP降低,与AMI 7 d时及对照组同期比较,差异有统计学意义(P0.05)。结论 AMI后择期PCI,开通IRA,可明显改善心功能及临床预后。     

3D-STI用于定量分析AMI患者PCI术后早期左心室心肌应变的变化

目的探讨三维斑点追踪技术(3D-STI)定量分析急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI后早期左心室心肌应变与心功能的关系。方法选取在我院治疗的前降支病变所致AMI患者50例(观察组),同时选取健康体检者50例(对照组),均给予3D-STI检查,测量左心室整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)、径向应变(GRS)及左心室射血分数(LVEF)。结果观察组GLS、GCS、GAS分别为(-10. 83±2. 43)%、(-10. 89±2. 11)%和(-18. 57±4. 22)%,明显高于对照组(t=13. 01～14. 98,P 0. 01),而GRS和LVEF分别为(27. 75±4. 47)%和(47. 30±2. 66)%,明显低于对照组(t=-13. 49、-12. 79,P 0. 01);观察组PCI术后1个月GLS、GCS和GAS分别为(-12. 55±2. 57)%、(-12. 13±2. 40)%、(-20. 45±4. 84)%较术前有所降低(t=5. 33～6. 53,P 0. 01),而GRS和LVEF分别为(31. 74±6. 11)%、(49. 20±3. 00)%较术前有所升高(t=-6. 55、-3. 45,P 0. 01);观察组PCI手术前后GLS、GCS和GAS变化值与LVEF变化值呈负相关(r=-0. 81、-0. 78和-0. 79,P 0. 01),而GRS变化值与LVEF变化值呈正相关(r=0. 81,P 0. 01)。结论 3D-STI可用于定量分析AMI患者PCI后早期左心室心肌应变及心功能情况,为疗效评估提供客观参数。     

三阶段健康教育对急性心肌梗死PCI治疗患者的影响

目的探讨三阶段健康教育对于急性心肌梗死(AMI)择期经皮冠状动脉介入(PCI)治疗患者,在治疗依从性、AMI并发症、住院满意度、出院后情况的影响。方法选取AMI并行择期PCI的患者,将其随机分为观察组(n=80)和对照组(n=80),对照组施行常规健康教育,观察组施行三阶段健康教育,采用调查问卷的方式进行评价。结果观察组与对照组住院期间治疗依从性比较,观察组配合度明显高于对照组,差异有统计学意义(P <0. 05);住院期间并发症发生率比较,心律失常、心力衰竭发生率观察组明显低于对照组,差异有统计学意义(P <0. 05);住院满意度观察组明显高于对照组,差异有统计学意义(P <0. 05);出院后观察组能够坚持锻炼、戒烟、改善饮食、门诊复诊化验检查等情况明显好于对照组,心脏不良事件发生率明显低于对照组,差异有统计学意义(P <0. 05)。结论对AMI行择期PCI的患者进行三阶段健康教育,可以明显提高治疗依从性,减少住院期间AMI并发症,提高住院满意度,改善出院后情况,降低心脏不良事件发生率。     

急性心肌梗死患者PCI术后并发急性脑梗死的发生率及其危险因素

目的:探讨急性心肌梗死(acute myocardial infarction,AMI)经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者术后并发急性脑梗死的发生率及其危险因素。方法:回顾性分析我科于2008年1月2014年1月收治的635例AMI行PCI术的患者,搜集到20例术后出现脑梗死的患者,未发生脑梗死的患者615例作为对照组,分析两组临床资料。结果:AMI患者进行PCI术后发生脑梗死20例,其发生率为3.1%。Logistic回归分析表明:术后并发脑梗死的危险因素,年龄、术后低血压、广泛前壁心梗、房颤、球囊扩张次数(P<0.05,OR>1)为术后并发脑梗死的独立危险因素。抗凝血酶(AT-Ⅲ)的降低是并发脑梗死的危险因素(P<0.05,OR<1)。结论:AMI行PCI后并发脑梗死的发生率为3.1%,年龄、术后低血压、广泛前壁心梗、房颤、球囊扩张次数为AMI行PCI术后并发脑梗死的独立危险因素,抗凝血酶为保护因素。     

三维超声心动图右心室特征对急性左心室下壁心肌梗死患者PCI术后心力衰竭的预测价值

目的]探究三维超声心动图右心室特征对急性左心室下壁心肌梗死(INFMI)患者经皮冠状动脉介入治疗(PCI)后心力衰竭(HF)的预测价值。 [方法]纳入2018年10月—2021年10月261例INFMI患者,根据PCI术后1年随访记录分为心力衰竭组(n＝42)和无心力衰竭组(n＝219)。比较两组临床资料和心动图特征;采用LASSO-Logistic回归筛选术后HF发生的独立影响因素;构建列线图模型并验证。 [结果]经筛选,在最优λ值处LASSO模型纳入INFMI患者游离壁中间段和整体纵向应变、流入道舒张期末容积和射血分数、体部舒张期末容积和射血分数。术后体部射血分数降低(截断值43.27%)、流入道射血分数降低(截断值51.49%)、整体纵向应变升高(截断值－13.52%)对HF有较高预测价值。联合年龄、Killip分级、N末端脑钠肽前体(NT-proBNP)构建列线图模型区分度较高,一致性指数0.981(95%CI:0.872～0.997),预测值与实际值拟合度较好。 [结论]INFMI患者右心室整体纵向应变、流入道和体部射血分数联合年龄、Killip分级、NT-proBNP对PCI术后1年HF风险具有较高的预测价值,预测模型可作为临床决策工具使用。     

分阶段心脏康复治疗对急性心肌梗死PCI术后病人心肺功能的影响

目的:分析分阶段心脏康复治疗对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后病人心肺功能的影响。方法:选取2021年9月—2022年3月于本院行急诊PCI的AMI病人120例,按入院先后顺序分为对照组(60例)和研究组(60例)。对照组进行常规护理与治疗,研究组在对照组基础上实施分阶段心脏康复治疗。比较两组心肺功能、左室射血分数(LVEF)、血管内皮功能、不良事件发生率。结果:PCI术后6个月,两组最大摄氧量(VO₂max)、无氧阈、氧脉搏均高于PCI术后1周,且研究组高于对照组,差异均有统计学意义(P<0.05)。LVEF的时间变化与组别之间具有交互作用(P<0.05);组间比较,PCI术后1周、3个月、6个月,研究组LVEF均大于对照组(P<0.05);PCI术后1周、3个月、6个月,两组LVEF呈逐渐升高趋势(P<0.05)。一氧化氮(NO)的时间变化与组别之间具有交互作用(P<0.05);组间比较,PCI术后1周、3个月、6个月,研究组NO均大于对照组(P<0.05);PCI术后1 d、1周、3个月、6个月,两...     

高龄急性心肌梗死患者PCI治疗有效性及安全性

目的分析急性心肌梗死(AMI)老年患者的临床特征,并探讨应用急诊经皮冠状动脉介入术(PCI)治疗的有效性及安全性。方法老年AMI并行急诊PCI治疗的患者96例,根据年龄分为低龄老年组(65～74岁) 59例和高龄老年组(≥75岁) 37例。比较两组一般资料、冠状动脉造影、介入治疗相关指标及术后症状、术后并发症情况。结果两组性别、高血压、糖尿病、高脂血症、脑梗死发生率、吸烟率及胸痛类型、肾功能不全、肝功能异常、房颤发生率、不同性别的左室舒张末期内径、射血分数、Killip分级及入院血小板计数、静脉应用硝酸酯类药物比例、门-球时间、住院时间(排除死亡患者)比较,差异均无统计学意义(均P>0. 05)。高龄老年组的血清D-二聚体水平显著高于低龄老年组(P<0. 04),血红蛋白浓度低于低龄老年组(P<0. 05)。两组心电图梗死图形比较,低龄老年组非ST段抬高型心肌梗死发病率显著高于高龄老年组(P<0. 05),其余类型〔前壁、下壁(包括右心室及正后壁)、高侧壁心肌梗死〕发生率比较,差异无统计学意义(P>0. 05)。两组左主干病变、病变血管平均数、"罪犯"血管、"罪犯"血管完全闭塞、非"罪犯"血管慢性闭塞发生率比较,差异无统计学意义(P>0. 05);侧支循环建立率、术前TIMI分级<3级、术后TIMI分级<3级发生率、单纯球囊扩张率比较差异亦无统计学意义(P>0. 05)。高龄老年组多支病变发生率明显高于低龄老年组(P<0. 05),术中使用升压药比例明显高于低龄老年组(P<0. 05),"罪犯"血管支架植入数量明显高于低龄老年组(P<0. 05)。两组术后胸痛症状均明显缓解,再发心绞痛、急性左心衰、出血及死亡的发生率比较差异无统计学意义(P>0. 05)。结论急诊PCI治疗AMI老年患者安全有效。     

互联网AISAS模式对急性心肌梗死PCI术后患者的护理效果

目的 探讨基于用户决策行为分析（AISAS）模式的互联网为基础的疾病管理应用于急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者的效果。方法 按照随机数字表法将我院2019年1月至2021年1月期间收治的87例急性心肌梗死PCI术后患者分为两组,对照组43例给予常规护理,观察组44例给予基于AISAS模式的互联网为基础的疾病管理干预。观察两组心功能指标、炎症因子及生活质量。结果 干预前,两组左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）对比差异无统计学意义（P>0.05）,干预6个月后,两组LVESD、LVEDD均降低,且观察组低于对照组,两组LVEF均升高,且观察组高于对照组（P<0.05）;干预前,两组白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白（Hs-CRP）水平对比差异无统计学意义（P>0.05）,干预6个月后,两组均降低,且观察组低于对照组（P<0.05）;干预前,两组简易生活质量评分（SF-36）各维度对比差异无统计学意义（P>0.05）,干预6个月后,两组均升高...     

RT3DE评价延迟PCI对急性心肌梗死患者心功能的影响

目的应用实时三维超声心动图(RT3DE)评价延迟经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者左心室功能的影响。方法选择首次AMI住院患者56例,根据是否行延迟PCI治疗,将患者分为PCI治疗组(30例)和药物治疗组(26例)。所有患者于治疗前和治疗后3个月、6个月分别进行RT3DE检查,对采集的三维超声图像进行脱机处理,得出左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及左心室射血分数(LVEF),比较两组患者左心功能的差异。结果PCI治疗组治疗后3个月、6个月较术前LVEDV、LVESV降低(P0.05),LVEF提高(P0.05)。药物治疗组治疗3个月、6个月时,各指标差异均无统计学意义。治疗后3个月及6个月时PCI治疗组与药物治疗组比较,LVEDV、LVESV、LVEF均有统计学意义(P0.05)。结论延迟PCI能明显改善AMI后左室重构,提高左心功能,改善患者预后。RT3DE可准确、方便的评价AMI患者左室整体心功能。     

急性心肌梗塞后左室舒张功能影响因素的探讨

为探讨急性心肌梗塞（ＡＭＩ）左室舒张功能的变化及影响因素，我们用脉冲多普勒超声心动图测量了７２例ＡＭＩ患者的左室舒张功能，并用多元逐步回归对其影响因素进行了分析。结果表明，７２例病人中Ｅ／Ａ＜１者４１例，占５６．９％。ＡＭＩ后左室舒张功能除受年龄影响外，梗塞面积的大小直接影响左室舒张功能，但与梗塞部位无关，梗塞前心绞痛可减轻梗塞后左室舒张功能的损害，是通过减小梗塞面积而实现的。溶栓治疗可以改善心肌梗塞后的左室舒张功能。     

Serial changes in left ventricular size after acute myocardial infarction.

The prognosis is poor for patients with left ventricular enlargement associated with large infarcts. We studied 78 patients using gated single-photon emission computed tomography (SPECT, to assess left ventricular volumes), right heart catheterization (to measure pulmonary wedge pressure and cardiac output), and conventional planar radionuclide ventriculography (to estimate ejection fraction), 2-6 days, 3-5 weeks, and 5-8 months after their first myocardial infarction. Patients were assigned to a large or small infarct-size group based on creatine kinase analysis. In 37 patients with large infarcts, left ventricular volume increased and was greater than 27% after 5-8 months than after 2-6 days (p less than 0.05). Although ejection fraction remained significantly depressed, stroke volume, which initially declined, was restored as a result of dilation and thus returned to normal by 3-5 weeks, indicating that enlargement of the left ventricle compensated for the loss of contractile myocardium and depression of global ejection fraction. The progressive nature of left ventricular dilation suggested that this process is of major pathophysiologic importance and that it plays an etiologic role in the genesis of heart failure and perhaps of sudden death following myocardial infarction. Dilation preceded hemodynamic deterioration, which became evident on exercise after 5-8 months in patients with large infarcts.     

Relation of coronary arterial patency and left ventricular function to electrocardiographic changes after streptokinase treatment during acute myocardial infarction

One hundred and eighty-eight patients with evolving acute myocardial infarction were treated with intravenous streptokinase. Serial 12-lead electrocardiograms were recorded for 3 hours after treatment and inspected for rapid repolarization changes of the ST segment and T wave. Abrupt electrocardiographic repolarization changes were observed in 106 patients (56%) and were strongly predictive for an open infarct-related coronary artery at a mean of 6 days after treatment (predictive value = 0.92, sensitivity = 0.67). Abrupt electrocardiographic changes were not observed in 82 patients (44%). This absence was not a good predictor of an occluded infarct-related coronary artery (predictive value = 0.4). There was no relation between the presence or absence of abrupt electrocardiographic changes and global or regional left ventricular function after streptokinase treatment. Abrupt repolarization changes after thrombolytic treatment indicate a high probability of an open infarct-related artery. When abrupt repolarization changes do not occur, the patency of the infarct-related coronary artery cannot be predicted with accuracy. Serial electrocardiographic recordings do not provide sufficient information about coronary patency to eliminate the need for coronary arteriography.     

心肌梗死患者心功能的预测因素

21世纪,心血管疾病已经超越传染病和肿瘤成为人类健康的头号杀手,其中最为凶险的就是急性心肌梗死。统计资料显示,全球每年有1700万人死于心血管疾病,其中一半以上死于急性心肌梗死。目前研究证实,心梗后约有56％的患者会出现心功能下降,而1／3的患者会发展成为心力衰竭。心力衰竭不但会直接影响患者的生存质量,同时又是介入治疗后晚期血栓形成的重要预测因素,因此,临床工作中全面了解心梗患者心功能的预测因素,积极进行处理事关重要。     

QT dispersion and left ventricular function after stent placement in acute myocardial infarction

BACKGROUND: QT dispersion is increased in acute myocardial infarction (AMI), but the relation of QT dispersion to left ventricular (LV) function has not yet been fully elucidated. The purpose of this study was to evaluate the relationship between QT dispersion and LV function in patients with successful coronary stenting in AMI. METHODS: Seventy five patients with AMI who underwent percutaneous transluminal coronary angioplasty (PTCA) were enrolled in this study. Corrected QT dispersion was measured before, immediately after, 24 h after, 48 h after, and 6 months after PTCA. Left ventricular ejection fraction (LVEF) was evaluated by left ventriculography at 6 months after PTCA. RESULTS: Corrected QT dispersion at 24 h after and 48 h after PTCA were significantly related to LVEF by univariate analysis (r=-0.282, p<0.05 and r=-0.326, p<0.01, respectively). In multiple regression model, corrected QT dispersion at 24 h after and 48 h after PTCA revealed significant associations with LVEF (R(2)=0.441, coefficient=-0.283, p=0.006 and R(2)=0.411, coefficient=-0.225, p=0.039, respectively), but corrected QT dispersion before, immediately after, and 6 months after PTCA were not associated with LVEF. CONCLUSIONS: Corrected QT dispersion at 24 h after and 48 h after PTCA in AMI correlate with LVEF at 6 months after PTCA.     

Coronary collaterals and left ventricular function early after acute transmural myocardial infarction

The coronary collateral circulation and ventricular function,segmental wall motion and infarct size, were investigated fromhemodynamic and angiographic data in 126 patients with acutetransmural myocardial infarction and complete obstruction ofa major coronary vessel. The patients were divided into twogroups: 74 with obstruction of the right coronary artery and52 with obstruction of the left anterior descending artery.The collateral circulation was rated as absent, poor, fair oradequate: two weeks after infarction, collateral vessels wereobserved in only 27% (poor 15.4%, fair 5.8%, adequate 5.8%)of the patients with an anterior myocardial infarction and inonly 35% (poor 13.5%, fair 16.4%, adequate 4.5%) of the patientswith an inferior myocardial infarction. In both groups of patients, the presence of collateral vesselshad no significant influence on the following parameters: leftventricular performance (left ventricular end-diastolic pressure,left ventricular enddiastolic volume, ejection fraction andmean velocity of fiber shortening), extent of abnormally contractingsegment and segmental wall motion. After anterior myocardialinfarction, there was an insignificant trend to lesser myocardialdamage in patients with coronary collaterals. Thus, coronary collaterals are infrequent in patients with acutetransmural myocardial infarction and total obstruction of acoronary vessel; in these patients we conclude that the collateralshave no effect either on left ventricular function or on thesize of the infarction.     

N-末端脑钠尿肽原诊断急性心肌梗死患者左室舒张功能的价值及其判断预后的意义

目的: 利用超声心动图,探讨N-末端脑钠尿肽原（NT-proBNP）对急性心肌梗死(AMI)患者左室舒张功能的评价及其意义。方法: 入选左室收缩功能正常的AMI患者66例,测定血浆NT-proBNP水平。根据组织多普勒超声（TDI）及二尖瓣血流频谱指标评价的左室舒张功能,将患者分为4组:A组:左室舒张功能正常组（n=16）;B组:轻度左室舒张功能减低（LVDD）组（n=21）;C组:中度LVDD组（n=24）;D组:重度LVDD组（n=5）。对患者随访12个月,临床终点是因心衰加重或再梗所致再住院和心源性死亡。结果: NT-proBNP水平随着LVDD的加重而显著增高（P<0.01）。NT-proBNP能够独立于其它影响因素判断LVDD,当其水平为962.1 μg/L时,判断LVDD的敏感性是76%,特异性是75%。12个月后发生终点事件患者的血浆NT-proBNP水平与未发生者相比差异有统计学意义（P<0.05）。结论: AMI后NT-proBNP水平能够独立评价LVDD并判断预后。它可用于对AMI患者危险分层并指导临床治疗。