用心肌声学造影评价择期经皮冠状动脉介入治疗改善心肌梗死患者心肌组织灌注的效果Clincial assessment on myocardium perfusion of myocardial infarction after selective PCI using MCE techniques
陈韵岱,田峰,吕树铮,房芳,李治安
摘要(Abstract)：
目的应用选择性心肌声学造影(MCE)评价择期经皮冠状动脉(冠脉)介入治疗(PCI)改善心肌梗死患者心肌组织灌注的临床疗效。方法选择24例前壁心肌梗死患者,发病到择期PCI的时间为6±2(3~12)周,于PCI前选择性冠脉内注射声诺维(Sonovue),利用对比脉冲序列成像技术(CPS)进行心肌声学造影(MCE)检查;冠脉开通后30 min再次行MCE检查,采用CUSQ软件进行脱机图像分析,计算心肌微血管血流量、最大造影剂充盈缺损面积和缺血心肌改善指数,评价心肌组织灌注效果。随访患者心脏功能及PCI术后30 d的主要心脏事件(MACE)。结果(1)24例患者的“罪犯”血管完全开通,TIMI血流3级;(2)冠脉内注入造影剂即刻能够获得清晰心肌显影,所有患者均获得较满意左心室及心肌显影效果。MCE显示,24例于PCI术前“罪犯”左前降支血管对应心脏节段节段性充盈减低或无造影剂充盈,PCI术后30 min 92%(22/24)的患者心脏节段充盈较术前显著改善,局部血流量值较术前提高;(3)24例患者PCI术后72 h左心室射血分数(EF值)较术前增加(52%±10%比62%±6%,P<0.05),住院期间无MACE发生。本研究中2例PCI术后心肌灌注不良患者,分别于术后1个月出现心力衰竭(心功能Ⅲ级),1例术后2周出现劳累性心绞痛,均经药物治疗稳定。结论选择性MCE技术是一项简便、安全的评价冠脉介入术心肌组织灌注的有效方法;未行再灌注治疗的心肌梗死患者应尽早行择期PCI术,挽救梗死区的缺血心肌,改善左心室功能。
关键词(KeyWords)： 心肌声学造影;心肌灌注;心肌梗死;血管成形术,经腔,经皮冠状动脉
基金项目(Foundation):
作者(Author): 陈韵岱,田峰,吕树铮,房芳,李治安
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