急诊血运重建对急性心肌梗死左心室功能的影响

目的应用二维超声心动图及多普勒组织成像（Doppler tissue imaging，DTI）评价急诊血运重建（包括静脉溶栓或者急诊冠状动脉支架置入术）对急性心肌梗死（acute myocardial infarction，AMI）左心室收缩和舒张功能的影响。方法入院后根据AMI患者治疗方法分为常规组和治疗组。常规组30例给予内科常规治疗；治疗组20例在内科常规治疗基础上实施静脉溶栓或急诊冠状动脉支架置入术。应用DTI检测左心室射血分数、二尖瓣血流舒张早期流速峰值（peak velocity at early diastole，VE）和舒张晚期流速峰值（peak velocity at late diastole，VA）比值（VE／VA），DTI成像模式检测二尖瓣环后间隔、侧壁、前壁、下壁、前间隔和后壁6个节段的收缩期运动速度峰值（peak velocity during systole，Sa）、舒张早期运动速度峰值（peak velocity at early diastole，Ea）和心房收缩期流速峰值（peak velocitv at atrial contraction，Aa），并计算Ea／Aa比值。各取6个节段的平均值。结果所有AMI患者于发病后1周、3月末左心室射血分数、VE／VA、Sa、Ea和Ea／Aa均较对照组降低；予急诊血运重建的AMI患者于AMI发病后3个月S。和E。较本组发病后1周增高，并较未行急诊血运重建干预组（常规组）发病后3个月增高。结论AMI后左心室收缩和舒张功能受损，实施急诊血运重建可以有效改善心脏功能．应用DTI技术检测二尖瓣环运动速度可以精确反映AMI患者局部节段性心功能的恢复。

Effect of emergency revascularization on left ventricular function in patients with acute myocardial infarction

Objective To evaluate the changes of the left ventricular function the patients with acute myocardial infarction (AMI) after the emergency revascularization (including intravenous thrombolysis and emergency intracoronary stent implantation) by 2D echocardiography and Doppler Tissue Imaging(DTI). Methods According to the different therapies, the patients with AMI were divided into 2 groups : A (Routine medical treatment group, n= 30), B (emergency revascularization group, n= 20). The left ventricle ejection farction (LVEF), ratio of early diastolic blood flow velocity of mitral valve(Ve) and blood flow velocity of atrium systolic period (Va) were measured by 2D echocardiography in patients with acute myocardial infarction and in the control group. And mitral annulus velocities from posteroseptal , lateral , anteroseptal ,posterior, anterior and inferior segments during systole(Sa), early diastole (Ea) and atrial contraction (Aa) were measured by Doppler Tissue Imaging(DTI), and then Ea/Aa was calculaterd. Results Compared to the control group , the LVEF,VE /VA, Sa, Ea and Ea/Aa on 1th week, 3th months after AMI with and without the emergency revascularization were significantly decreased. Compared to the 1th week after AMI with the emergency revascularization and the 3th months after AMI without the emergency revascularization, the Sa,Ea on 3th months after AMI with the emergency revascularization were significantly increased. Conclusions The left ventricle systolic and diastolic function were damaged after AMI . The emergency revascularization after AMI can efficiently improve left ventricular function. To detect mitral annulus velocities by DTI can precisely reflect the left ventricular function improvement in patients with AMI.