B超与声学造影对心梗前心肌微循环的评价

目的运用静脉心肌声学造影技术探讨心肌梗塞前心绞痛与心肌微循环、左室重构和收缩功能的关系。方法研究对象为本院29例急性心肌梗塞患者,根据梗塞前1周内有无心绞痛分成心绞痛组（A组）和无心绞痛组（B组）,其中A组17例,B组12例;男性23例,女性6例,年龄（63.3±7.5）岁。采用Philips Sonos 5500超声诊断仪、S4探头进行超声检查和经静脉心肌声学造影显像,造影剂采用德国先灵公司生产的Levovist。所有研究对象均进行了血管重建术,并于术后第5周复查二维超声。结果 （1）A组出现术后无再流现象的患者明显低于B组（P〈0.001）。（2）A、B两组的左室舒张末期内径（EDD）在术后第1周差别无显著意义（P〈0.05）,而在第5周A组的EDD明显小于B组（P〈0.05）。A组的EDD逐渐减小（P〈0.05）,而B组的EDD无明显变化（P〉0.05）。（3）A组的射血分数（EF）显著改善,而B组的EF无明显变化（P〉0.05）。结论心肌梗塞前心绞痛有利于血管重建术后心肌微循环和左室重构的改善,有助于左室功能的恢复。

Myocardial Microdruculation Before Myocardial Infarction Influenced by B Ultrasonic and Acoustic Contrast

OBJECTIVE To assess the relationship of angina and myocardial microcirculation before myocardial infarction,myocardial microcirculation,left ventricular remodeling and LVSF by myocardial contrast echocardiography（MCE）.METHODS Studying 29 patients with acute myocardial infarction.They are divided into two groups,which are Group A with 17 patients with angina pectoris and Group B with 12 without it,including 23 male and 6 female patients,with age of（63.3±7.5）.Philips Sonos 5500 ultrasonic diagnostic apparatus and S4 detector are used to do ultrasonic examination and intravenous myocardial contrast echocardiography.Levovist by Schering AG is used as contrast agent.Revascularization is used in all research objectives and reexamination is done in the fifth week after operation by two-dimensional ultrasound.RESULTS（1）The incidence of no flow was significantly lower in Group A than Group B（P0.001）.（2）The incidence of no dimension was not significantly different in Group A and Group B in the first week after revascularization.The EDD decreased significantly in the fifth week after revascularization in Group A,but not changed in Group B（P0.05）.EDD in Group A decreases gradually（P0.05）,but EDD in Group B didn＇t change significantly（P0.05）.（3）EF in Group A improved significantly,but it didn＇t change significantly in Group B（P0.05）.CONCLUSION Angina before myocardial infarction does favor to improve myocardial microcirculation and left ventricular remodeling,and to the recovery of left ventricular function.