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目的:应用多普勒组织成像(DTI)结合心肌声学造影(MCE)评估无复流发生时心脏收缩和舒张功能的变化。方法:健康杂种犬19只,均结扎左前降支(LAD)60min,而后分别再灌注60(n=6)、120(n=6)、180min(n=7)。(1)MCE检查:LAD结扎后MCE检查确定的低灌注区为危险区(RAMCE),再灌注后MCE检查确定的低灌注区为无复流区(NRAMCE)。若NRAMCE/RAMCE比值大于或等于25%时被认为发生了无复流现象,为无复流组;若NRAMCE/RAMCE比值小于25%时认为心肌复流,为复流组。(2)测定左室射血分数(EF)和室壁增厚率(ΔT%)。(3)使用DTI检测左室前壁s、e和a波速度,计算e/a。结果:复流组共有7只犬,无复流组共有10只犬。复流组EF随着再灌注逐渐恢复。然而,无复流组EF随着再灌注呈现进行性下降。在再灌注的同一时间点,无复流组的EF比复流组低,二者差异有统计学意义。再灌注后,复流组ΔT%逐渐恢复,但在再灌注180min时未能恢复到基础状态;无复流组ΔT%则随着再灌注的进行,无恢复征象。DTI测定的左室前壁频谱显示s波、e波速度在LAD结扎后显著降低,a波速度增加,e/a减小;再灌注后,复流组的s波、e波速度和e/a在再灌注60、120、180min不同时间点依次增大,a波速度有所降低;而无复流组的s波,e波速度及e/a则进行性降低,两组之间的差异有统计学意义(P均<0.05)。结论:与缺血后再灌注心肌复流相比,无复流时心肌收缩和舒张功能不能恢复。随着无复流面积的扩大,这种变化有进一步恶化的趋势。DTI是一个敏感、可靠地评估心脏收缩和舒张功能工具。
Objective: To evaluate the changes of systolic and diastolic function in patients with no-reflow by Doppler tissue imaging (DTI) combined with myocardial contrast echocardiography (MCE). Methods: Twenty nine healthy mongrel dogs were anesthetized with LAD for 60 min and then reperfused 60 (n = 6), 120 (n = 6) and 180 min (n = 7) respectively. (1) MCE examination: The low perfusion area determined by MCE examination after LAD ligation is risk area (RAMCE), and the low perfusion area confirmed by MCE examination after reperfusion is NRAMCE. If NRAMCE / RAMCE ratio is greater than or equal to 25%, no-reflow phenomenon is considered as no-reflow group; if NRAMCE / RAMCE ratio is less than 25%, myocardial re-flow is considered as re-flow group. (2) Left ventricular ejection fraction (EF) and wall thickening rate (ΔT%) were measured. (3) Calculate e / a using DTI to detect s, e and a wave velocities of the left ventricular anterior wall. Results: There were 7 dogs in the reperfusion group and 10 dogs in the no-return group. The reperfusion group EF gradually recovered with reperfusion. However, no-reflow group EF showed a progressive decline with reperfusion. At the same time point of reperfusion, EF in no-reflow group was lower than that in re-flow group, the difference was statistically significant. After reperfusion, the ΔT% of the reperfusion group gradually recovered, but failed to return to the basal state at 180 minutes of reperfusion; ΔT% of the no-reperfusion group followed the reperfusion, and no signs of recovery were found. The left ventricular anterior wall spectrum measured by DTI showed that s wave and e wave velocity decreased significantly after LAD ligation, a wave velocity increased and e / a decreased. After reperfusion, s wave, e wave velocity and e / a increased at different time points after reperfusion for 60,120,180min, the velocity of a wave decreased, while the s wave, e wave velocity and e / a of the no-reflow group decreased progressively. The differences between the two groups There was statistical significance (all P <0.05). CONCLUSION: Myocardial contractile and diastolic function can not be recovered in the absence of reflow compared with myocardial reperfusion after ischemia. With the expansion of no-reflow area, this kind of change tends to worsen further. DTI is a sensitive and reliable tool for assessing systolic and diastolic function.