本文選題：超聲心動圖 + 右冠狀動脈慢性閉塞　； 參考：《首都醫(yī)科大學(xué)學(xué)報》2017年04期

【摘要】：目的用二維超聲心動圖觀察右冠狀動脈(right coronary artery,RCA)慢性完全閉塞病變(chronic total occlusion,CTO)合并陳舊下壁心肌梗死病人右心功能的變化情況并探討其臨床意義。方法首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院2013年6月至2016年10月收治的28例RCA-CTO合并陳舊下壁心肌梗死病人,根據(jù)冠狀動脈造影結(jié)果分為側(cè)支循環(huán)良好組和側(cè)支循環(huán)不良組,術(shù)前應(yīng)用超聲心動圖測量2組右心室面積變化率(right ventricular fractional area change,RVFAC)、三尖瓣環(huán)收縮期位移(tricuspid annular plane systolic excursion,TAPSE)、心肌綜合指數(shù)(myocardial performance index,MPI),多普勒超聲心動圖測量三尖瓣口舒張期血流速度(E、A峰值),組織多普勒(tissue Doppler imaging,TDI)測量三尖瓣環(huán)舒張期運動速度(e’及a’值),比較2組臨床特點、介入手術(shù)情況、術(shù)后心血管不良事件發(fā)生情況和平均住院時間。結(jié)果 2組比較,側(cè)支循環(huán)不良組術(shù)前RVFAC、TAPSE較低,MPI、E/A比值及E/e’比值較高,提示側(cè)支循環(huán)不良組較側(cè)支循環(huán)良好組右室收縮及舒張功能均下降(P0.05);2組介入手術(shù)情況比較,側(cè)支循環(huán)良好組術(shù)中嚴重心律失常發(fā)生0例,側(cè)支循環(huán)不良組術(shù)中嚴重心律失常發(fā)生8例,占44.4%,2組差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后發(fā)生嚴重心律失常在側(cè)支循環(huán)良好組中有0例,側(cè)支循環(huán)不良組有7例占38.9%,差異有統(tǒng)計學(xué)意義(P0.05);2組平均住院天數(shù)比較,側(cè)支循環(huán)不良組住院時間較長(P0.05)。結(jié)論 RCA-CTO合并陳舊下壁心肌梗死病人側(cè)支循環(huán)形成不良較側(cè)支循環(huán)形成良好者右心功能下降明顯,術(shù)前二維超聲心動圖對此類病人右心功能的評估可以評價此類病人側(cè)支循環(huán)形成良好與不良之間的差異,具有一定的臨床意義。
[Abstract]:Objective to observe the changes of right ventricular function in patients with chronic total occlusion of right coronary artery (RCA) and inferior wall myocardial infarction (AMI) by two dimensional echocardiography and to explore its clinical significance. Methods from June 2013 to October 2016, 28 patients with RCA-CTO complicated with obsolete inferior wall myocardial infarction were treated in Beijing Anzhen Hospital affiliated to Capital Medical University. According to the results of coronary angiography, they were divided into two groups: good collateral circulation group and bad collateral circulation group. Right ventricular fractional area change rate, tricuspid annular plane systolic excursion, myocardial complex index myocardial performance index MPII and tricuspid annular plane systolic excursion were measured by echocardiography before operation. Doppler echocardiography was used to measure the diastolic velocity of tricuspid valve. The diastolic velocities of tricuspid annulus were measured by tissue Doppler imaging (TDI), and the clinical characteristics of the two groups were compared. Interventional surgery, postoperative cardiovascular adverse events and the average length of hospital stay. Results compared with the two groups, the RVFACU / TAPSE was lower and the ratio of MPI / E / A and E / E 'was higher in the group of bad collateral circulation before operation than that in the group of bad collateral circulation. It suggested that the systolic and diastolic function of right ventricle in the group with poor collateral circulation was lower than that in the group with good collateral circulation (P 0.05). There were 0 cases of severe arrhythmia in the good collateral circulation group and 8 cases in the bad collateral circulation group, accounting for 44.4% of the difference between the two groups (P 0.05), and there were 0 cases of serious arrhythmia in the good collateral circulation group after operation. There were 7 cases of bad collateral circulation group (38.9 cases). The difference was statistically significant. The average hospitalization days of the two groups were significantly higher than that of the control group (P 0.05). The length of stay in the group with bad collateral circulation was longer than that in the control group (P 0.05). Conclusion the right ventricular function decreased significantly in patients with RCA-CTO complicated with inferior myocardial infarction. The evaluation of right ventricular function by two dimensional echocardiography before operation can evaluate the difference between good and bad collateral circulation formation in these patients and has certain clinical significance.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院超聲心動圖一部;首都醫(yī)科大學(xué)基礎(chǔ)醫(yī)學(xué)院醫(yī)學(xué)遺傳學(xué)與發(fā)育生物學(xué)學(xué)系;
【基金】：北京自然科學(xué)基金(7141002)~~
【分類號】：R540.45;R542.22

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