超声心动图诊断急性心肌梗死及其并发症的价值
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| 时间：2009-01-16 20:37:03 来源： 作者： |
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Value of echocardiography in the diagnosis of acute myocardial infarction and its complications
MU Yi， SANG Yu-shun，XU Yong-li，SHI Hai-jian.
Department of Ultrasound，101th Hospital of Chinese PLA，Jiangsu 214044，China
【Ａｂｓｔｒａｃｔ】 Objective To evaluate the value of echocardiography in the diagnosis of acute myocardial infarction and its complications．Methods The echocardiographic features of 62 patients who were admitted to our hospital within two weeks of the onset of acute myocardial infarction were analyzed retrospectively. The results of acute myocardial infarction estimated by echocardiography and electrocardiography were compared. The complications of acute myocardial infarction were recorded. Results The localization and size of acute myocardial infarction estimated by echocardiography and electrocardiography were consistent on the whole. Among 62 patients with acute myocardial infarction，57 cases showed myocardial infarction and 23 cases showed as ventricular aneurysm(n=11)，thrombosis in left ventricule(n=2)，ventricular interseptal perforation(n=3)，and medium and serious mitral regurgitation(n=7)． Conclusion Echocardiography is a simple and accurate method to detect acute myocardial infarction in time when combined with electrocardiography in the diagnosis of acute myocardial infarction．
【Ｋｅｙ ｗｏｒｄｓ】 Echocardiography；Acute myocardial infarction；Complication.
急性心肌梗死是冠心病的一种特殊而严重的类型，其常见并发症有心律失常、心包炎和室壁瘤形成，也可发生腱索或乳头肌断裂、室壁穿孔等严重并发症，有时危及患者生命。不少临床医师比较重视心电图、心肌酶谱、胸部X线、选择性冠状动脉造影等检查，对超声心动图在急性心肌梗死诊断中的潜在用途尚缺乏足够认识。本文回顾性分析62例急性心肌梗死患者的超声心动图资料，旨在探讨超声心动图在诊断急性心肌梗死及其并发症的应用价值。
资料与方法
一、临床资料
急性心肌梗死患者62例，男37例，女25例，年龄35～82岁，平均(64±9)岁。其中广泛前壁心肌梗死15例，广泛前壁合并下壁心肌梗死4例、广泛前壁合并右室心肌梗死1例；前壁心肌梗死11例，前壁合并下壁心肌梗死2例、合并下壁及右室心肌梗死1例；前间壁心肌梗死8例，前间壁合并下壁或右室心肌梗死各1例；下壁心肌梗死7例，下壁合并后壁心肌梗死6例、合并右室心肌梗死1例；后壁心肌梗死2例；右室心肌梗死1例；非Q波心肌梗死1例。
二、仪器与方法
应用Philips公司HP SONOS 5500 型及iU 22 彩色多普勒超声诊断仪，探头频率分别为2.0～4.0 MHz、1.0～5.0 MHz。于患者急性发病2周内、冠状动脉造影前或造影后3天进行超声心动图检查。常规扫查时取胸骨旁左室长轴观，二尖瓣水平、乳头肌水平和心尖水平左室短轴观，心尖四腔观和二腔观。必要时加做心尖左室长轴、胸骨旁四腔观、剑突下四腔观和右室流入道长轴观等。除常规检查测量外，重点观察心脏各节段室壁运动情况、室壁厚度变化、心肌回声强度以及彩色多普勒血流状态。室壁运动分析采用美国超声心动图协会推荐的左室壁16节段（左室壁分为：前间隔、后壁、前壁、下壁、室间隔及侧壁；其中前间隔及后壁各分为中段、基底段，前壁、下壁、室间隔、侧壁各分为心尖段、中间段、基底段。）、右室壁6节段（右室壁分为：游离壁、室间隔；游离壁、室间隔各分为心尖段、中间段、基底段）划分法。
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