床旁超声心动图对急性心肌梗死后左室舒张功能的评价

目的　应用床旁超声心动图动态观察心肌梗死急性期左室舒张功能 (LVDF)的变化 ,评价溶栓治疗对其的影响。方法　对 61例首发急性心肌梗死 (AMI)患者行系列床旁超声心动图检查。检测指标包括 :舒张早晚期最大充盈速率比值 (VE/VA)及其时间流速积分比值 (ETVI/ATVI)和等容舒张时间 (IVRT )。结果　AMI患者IVRT均延长 ,前壁心肌梗死溶栓组和下壁心肌梗死组VE/VA下降 ,前壁心肌梗死未溶栓组VE/VA正常。溶栓再通组第 3dIVRT、ETVI/ATVI明显改善 ,第 7d、3周末持续改善。溶栓未通组、未溶栓组各指标无显著变化。前壁溶栓再通组与溶栓未通组及未溶栓组同期比较IVRT有显著性差异。结论　AMI患者急性期LVDF减退 ,溶栓再通后LVDF明显改善 ,但存在舒张顿抑。床旁超声心动图评价AMI后LVDF的变化有良好的临床应用价值。

Evaluation of left ventricular diastolic function by serial Doppler echocardiography after acute myocardial infarction

Objective To evaluate the effect of thrombolytic therapy on left ventricular diastolic function(LVDF) in patients with acute myocardial infarction (AMI).Methods Serial pulse Doppler echocardiography was performed before thrombolysis and during the 3rd day and 3rd weekend after thrombolysis in 61 patients with AMI.The ratio of early to late atrial diastolic peak flow velocity(VE/VA),the ratio of early to late atrial time velocity integral (ETVI/ATVI) and isovolumic relaxation time(IVRT) were observed.Results IVRT of all cases was prolonged; VE/VA was decreased in inferior wall infarction, however,VE/VA was normal in anterior wall infarction. In reperfusion group, IVRT was decreased and ETVI/ATVI was increased significantly on the 3rd days; Moreover,these values persistently were improved on the 7th day and at the 3rd weekend. In non reperfusion group and non thrombolysis group, these values showed no significant changes within 3 weeks. IVRT in three groups of anterior wall MI were significantly different.Conclusions The patients with AMI exhibited abnormal LVDF. Successful thrombolytic therapy could improve LVDF. Doppler echocardiography is a useful method in evaluating LVDF after AMI.