· 临床研究·

    基金项目: 国家自然科学基金委资助(39970710)

    作者单位: 100700 北京军区总医院超声科

    室壁节段性运动异常与冠状动脉疾病

    解剖学变化特点的超声研究

    黄小琴 万晓荆 丁桂春 简文豪 刘梅 张轻

    【摘要】 目的 应用超声心动图探讨室壁节段性运动异常对冠状动脉疾病心脏解剖结构的影响 ,以

    及对疾病严重程度的认定。方法 受检对象共 125 例。冠状动脉疾病组 63 例(其中普通患者 41 例 ,急性

    心肌梗死7例 ,陈旧性心肌梗死 15例) ,全部病例分别经临床冠状动脉搭桥术、球囊扩张并支架安放术、冠

    脉造影及放射性核素扫描证实;正常对照组 62 例。二维超声选用标准的左室短轴和长轴观声像图 ,显示

    室壁节段性运动异常构成心室整体的向心性非协调性运动和非向心性矛盾样运动;运用 M型超声连续扫

    查观察室壁节段性运动异常的典型特征。结果 63 例冠状动脉疾病患者中的 43 例(68. 2 %)显示为单发

    室壁节段性运动异常 ,20例(31. 8 %)则显示为多发室壁节段性运动异常( P < 0. 01) 。所有患者左室室壁

    节段性运动异常局部心内膜均显现回声增强 ,收缩运动幅度减低 ,舒张速度减慢。室壁节段性运动异常无

    论单发或多发 ,均被二维和M型超声清晰显示。58 例合并心房扩大 ,单纯左房扩大者 39 例。发生心肌梗

    死的22例重症患者中 ,有17例合并左、右心室不同程度的扩大。结论 无创性超声心动图可对室壁节段

    性运动异常所致冠状动脉解剖结构变化特点以及病变的严重程度提供客观准确的诊断资料。

    【关键词】 超声心动描记术;冠状动脉疾病;心室功能

    Echocardiographic study on anatomic changes of regional wall motion abnormality with coronary artery disease

    HUANG Xiao2qin , WAN Xiao2jing , DING Gui2chun , et al . Department of Ultrasonography , General Hospital of Beijing

    Minitary District , Beijing 100700 ,China

    【Abstract】 Objective To investigate the influence of regional wall motion abnormality( RWMA) on cardiac

    anatomic structure with coronary artery disease ( CAD) and to recognize serious degree of the disease by

    echocardiography. Methods A total of 125 cases was observed. There were 63 patients in CAD group (41 cases with

    general CAD ,7 cases with acute myocardial infarction and 15 cases with old myocardial infarction ) . All the patients had

    undergone respectively CABG,PTCA and stent ,coronary angiography or radionuclide scan for confirmation. There were

    62 cases in normal control group. Using 2D echocardiography ,stand short and long axis images of left ventricle(LV) were

    chosen. Displayed RWMA to compose the centripetal disharmonized motion with whole 2wall of LV ,and the discentripetal

    contradiction motion. M mode for continuous scan was to detect the typical characterisitic of RWMA. Results Single2

    occurring RWMA from 43 cases (68. 2 %) in 63 cases with CAD was displayed , while multiple 2 occurring RWMA from

    another 20 cases (31. 8 %) was displayed( P < 0. 01) . In all the patients , the echo increased ,the systolic amplitude

    decreased ,the diastolic velocity was lower than that of the normal ,from regional of RWMA. No matter whether it was

    single2 occurring or multiple2 occurring RWMA ,all were shown clearly by 2D and M mode echocardiography. The atrium

    was larger in 58 cases of all ,only left ventricular diamerer was larger in 39 cases of them. Left ventircular diameter and

    right ventircular diameter were increased in 17 serious cases of 22 patients with myocardial infarction. Conclusions

    Non2injury echocardiography provides objective diagnostic value on characteristic anatomic changes due to RWMA and

    serious degree of CAD.

    【Key words】 Echocardiography ; Coronary disease ; Ventricular function

    室壁节段性运动异常是提示冠状动脉病变与非病

    变区域局部心肌的运动状态比较。冠状动脉梗塞与狭

    窄性病变均可引发受累室壁区域的节段性运动异常以

    及局部心肌组织解剖学的病变。然而如何量化室壁的

    节段性运动异常 ,尤其对心脏解剖结构改变的影响以

    及对疾病严重程度的认定 ? 本研究应用二维和 M型

    超声心动图对比进行了评价。

    · 58 · 中华超声影像学杂志2004年2月第13卷第2期 Chin J Ultrasonogr ,February 2004 ,Vol 13 ,No. 2

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

    一、研究对象

    自2000年4月至2002年10月随机检测在我院接

    受诊治的患者及正常体检者 125 例。冠状动脉疾病

    (CAD)组63例 ,男性 51 例 ,女性 12 例 ,平均年龄 63. 3

    岁(32～83岁) ,其中包括普通患者 41 例 ,急性心肌梗

    死(AMI) 7 例 ,陈旧性心肌梗死(OMI) 15 例 ......