· 临床研究·

    作者单位:430022 武汉,华中科技大学同济医学院附属协和医院

    超声科(谢明星、王新房、吕清、杨娅、黄润青、卢晓芳、杨亚利) ,心导管

    室(王祥)

    经胸超声冠状动脉血流显像技术评价支架术

    前后冠状动脉血流储备的初步临床应用

    谢明星 王新房 王祥 吕清 杨娅 黄润青 卢晓芳 杨亚利

    【摘要】 目的 探讨经胸超声冠状动脉血流显像技术评估冠心病支架术前、后冠状动脉血流储备

    (CFR)的价值。方法 28 例冠状动脉前降支狭窄的冠心病患者对狭窄的冠状动脉行经皮冠状动脉内成形

    术(PTCA)后各置入 1 枚支架。分别于术前、术后 72 h内 ,采用经胸超声多普勒冠状动脉血流显像技术检

    测左冠状动脉前降支狭窄远端静息舒张期血流峰速( r2Vd) 、注射潘生丁时最大舒张期血流峰速(d2Vd)及

    CFR。结果 28 例患者行支架术均获成功 ,狭窄率由术前 84. 2 % ±8. 6 %降至术后 5. 4 % ±0. 8 % ,( P < 0. 05) 。28 例患者共 40 支病变血管中 ,34 支狭窄冠状动脉远端检测到多普勒频谱(检出率 85 %) 。

    支架术后 r2Vd较术前 r2Vd有增加趋势 ,但差异无显著性意义( P > 0. 05) ;术后静脉注射潘生丁后最大 d2

    Vd及 CFR均较术前明显增加[ (0. 94 ±0. 21) m/ s 对(0. 51 ±0. 18) m/ s ,3. 21 ±1. 21 对 1. 89 ±0. 40 ,均

    P < 0. 05 ]。结论经胸超声多普勒冠状动脉血流显像技术结合潘生丁试验是一种简便、易行、无创性评价

    冠心病患者冠状动脉介入治疗前后血流储备变化的新方法。

    【关键词】 超声心动描记术;血管成形术 ,经腔 ,经皮冠状动脉;支架;冠状动脉血流储备

    Initial exploration on noninva sive a sse ssment of coronary flow re serve using transthoracic coronary flow

    imaging before and after succe ssful coronary stent implantation XI E Ming2xing , WA N G Xin2f ang , WA N G

    Xiang , et al . Department of Ul t rasound , Union Hospital , Tongji Medical College , Huaz hang University of

    Science and Technology , Wuhan 430022 ,China

    【Abstract】 Objective To estimate the value of t ransthoracic coronary flow Doppler imaging to detect

    coronary flow velocity changes in patients undergoing coronary angioplasty and stenting and to assess coronary

    flow reserve(CFR) of the procedure. Methods Twenty2eight patients with coronary vessel disease undergoing

    stent implantion were studied with t ransthoracic pulsed Doppler guided by color flow imaging to record coronary

    diastolic peak velocicy at rest (r2Vd) and < 72 hours after the interventional procedure. Re sults Coronary flow

    velocity Doppler signals were successfully obtained in 34/ 40 narrowing coronary arteries (85 %) of 28 patients.

    Narrowing percent in diameter for 28 LAD decreased f rom 84. 2 % ±8. 6 % before to 5. 4 % ±0. 8 % after

    stenting ( P < 0. 05) . Both maximal d 2Vd and CFR significantly increased after stenting [ (0. 94±0. 21) m/ s vs

    (0. 52±0. 18) m/ s , 3. 21 ±1. 21 vs 1. 89 ±0. 40 , P < 0. 05 ] . After stenting , r2Vd tended to increase [ (0. 36 ±

    0. 18) m/ s vs (0. 24 ±0. 09) m/ s , P > 0. 05 ] . Impaired CFR after successful stenting (25 % ,7/ 28) was related

    to an increased resting flow velocity. Patients with an increase of CFR after stenting were characterized by an

    unaltered resting flow velocity and an increased dipyridamole2induced maximal flow velocity. Conclusions In

    patients with coronary artery stenosis , t ransthoracic coronary flow imaging combined with int ravenous

    dipyridamole shows improvement in CFR after successful stent implantation. This new method may be a feasible

    and promising technique for assessing CFR with a real noninvasive approach.

    【Key words】 Echocardiography ;Angioplasty , t ransluminal ,percutaneous coronary ; Stents ; Coronary flow

    reserve

    冠状动脉血流储备(coronary flow reserve ,CFR)

    是临床上评价冠状动脉循环功能的一个有效指

    标[1 ,2 ]。既往主要采用有创性的昂贵检查手段测量

    CFR ,使其临床应用上受到限制[3 ,4 ]。超声心动图冠

    状动脉血流显像技术是近年发展起来的一项评价冠状

    动脉血流速度变化的新技术 ,其通过脉冲多普勒测量

    冠状动脉血流速度变化来评价 CFR[5 ]。本研究应用

    此项技术结合潘生丁试验 ,观察冠心病患者支架术前、后 CFR的改变 ,探讨这一无创、简便的检测方法对评

    价冠心病患者介入治疗前后 CFR变化的应用价值。

    · 523 · 中华超声影像学杂志2003 年6 月第12 卷第6 期 Chin J Ult rasonogr ,J une 2003 ,Vol 12 ,No. 6

    ? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved.资 料 与 方 法

    一、研究对象

    选择支架术前经本院或外院心血管造影有前降支

    单处病变的心绞痛患者 28 例 ,男 21 例 ,女 7 例 ,年龄

    40～63 岁 ,平均(54. 2 ±6. 9) 岁 ......