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目的探讨应用实时心肌超声造影技术(RT-MCE)结合腺苷负荷试验检测缺血心肌的价值。方法在开胸犬中结扎左冠状动脉前降支(LAD)建立心肌缺血及梗死模型。分别采集基础状态、缺血状态及梗死状态下的RT-MCE图像,然后于三种状态下给予腺苷140μg.kg-1.min-1持续静脉微量泵注射6 min,重复上述记录。利用Qlab分析软件得出左室16节段的时间-强度曲线,测量在负荷前后平台期心肌显影强度(A)、曲线上升斜率(β)及A.β的变化。结果在基础状态下,冠状动脉各节段应用腺苷后A、β及A.β较用药前均显著增加(P<0.05)。在LAD节段,基础状态与缺血状态的A、β及A.β值差异无统计学意义(P>0.05),应用腺苷后缺血部位A值呈降低趋势,β及A.β略增加,但差异无统计学意义(P>0.05);梗死状态下,LAD节段的A、β及A.β值均较基础状态及缺血状态显著性降低(P<0.01,P<0.05),应用腺苷后A、β及A.β值较用药前差异无统计学意义(P>0.05)。结论实时心肌超声造影技术结合腺苷负荷试验可以定量检测缺血心肌,具有重要的临床应用价值。
Objective To investigate the value of real-time myocardial contrast echocardiography (RT-MCE) combined with adenosine stress test in detecting ischemic myocardium. Methods Left anterior descending coronary artery (LAD) was ligated in thoracotomy dogs to establish a model of myocardial ischemia and infarction. The RT-MCE images of the basal, ischemic and infarcted states were collected, and then the above records were repeated by intravenous injection of 140μg.kg-1.min-1 adenosine for 6 minutes in three states. The time-intensity curve of 16 segments of left ventricle was obtained by Qlab analysis software, and the changes of myocardial development intensity (A), slope of curve rise (β) and A.β before and after plateau were measured. Results Under the basal condition, the A, β and Aβ levels of adenosine in all coronary arteries were significantly increased (P <0.05) compared with those before administration. In the LAD segment, there was no significant difference in A, β and Aβ between the basal state and the ischemic state (P> 0.05). A value of ischemic site decreased with the application of adenosine, while β and A.β slightly (P <0.05). In infarction, the A, β and Aβ values of LAD segment were significantly lower than those of basal state and ischemic state (P <0.01, P <0.05), but the difference was not statistically significant , After application of adenosine A, β and A. β values before treatment was no significant difference (P> 0.05). Conclusion Real-time myocardial contrast echocardiography combined with adenosine stress test can quantitatively detect ischemic myocardium, which has important clinical value.