目的观察组织速度峰值(Sm)和组织位移峰值(D)在急性心肌梗死相关动脉(IRA)供血节段与非梗死相关动脉(NIRA)供血节段急性期的变化,并与正常人相应节段比较,探讨Sm和D能否敏感地评估缺血心肌、坏死心肌。方法以31例首次发病的急性心肌梗死(AMI)患者为研究对象,其中前壁AMI 14例,IRA为前降支(LAD);下壁AMI 17例,IRA为回旋支(LCX)10例,IRA为右冠状动脉(RCA)7例;所有患者均在发病24小时内获取其标准心尖二腔、长轴、四腔彩色组织多普勒,描记心肌各节段的TVI、TT曲线,测量基底段、中段、心尖部收缩相峰值。并与42例正常人对照分析。结果AMI患者的Sm和D与正常人比较结果显示:在前壁和前间隔所有IRA基底段、中段和部分NIRA基底段、中段峰值减低有显著或极显著的统计学差异(P<0.001或P<0.01、P<0.05),峰值减低程度IRA大于NIRA;在侧壁、下壁、后壁和室间隔所有NIRA基底段、中段和部分IRA基底段、中段峰值减低有显著或极显著的统计学差异(P<0.001或P<0.01、P<0.05),峰值减低程度NIRA大于IRA。AMI患者的Sm和D在IRA和NIRA比较提示我们,在前壁AMI组(除外前壁的Sm),前壁和下壁的基底段、中段的Sm和D可以区分梗死与非梗死心肌(P<0.05);在下壁AMI组(除外下壁AMI患者的Sm)侧壁、前间隔、后壁和室间隔中段的Sm和D可以区分梗死与非梗死心肌(P<0.05)。结论AMI患者的Sm和D与正常人比较不仅能够在急性缺血早期无创、定量、准确、敏感地区分正常及缺血、坏死心肌,也能够评估IRA和NIRA的缺血、坏死心肌,为临床提供了可床旁测量、方便快捷的诊疗手段。 Objective To observe the changes of tissue velocity peak (Sm) and tissue displacement peak (D) during the acute phase of blood supply in non-infarcted artery (NIRA) and blood supply in IRA-related artery (IRA) To compare whether Sm and D can assess ischemic myocardium and necrotic myocardium sensitively. Methods Thirty-one AMI patients were included in this study. Among them, 14 were AMI in the anterior wall and LAD were in the anterior wall; 17 were AMI in the inferior wall, 10 were LCA in the IRA, The IRA was performed in 7 cases of right coronary artery (RCA). All patients received standard two-chamber, long-axis and four-chamber color Doppler within 24 hours of onset of disease. The TVI and TT curves of each segment were recorded. Section, middle, apical systolic peak. And 42 cases of normal control analysis. Results Compared with normal subjects, Sm and D in AMI patients showed significant or very significant statistical difference (P <0.001 or P, P <0.001 or P <0.05) in the basal segment of the anterior wall and the anterior septum, <0.01, P <0.05). The IRA of peak reduction was greater than that of NIRA. There was a significant or extremely significant difference in peak reduction in the basal segment, middle segment and basal segment of IRA in all the NIRA basal segment, inferior wall, posterior wall and interventricular septum (P <0.001 or P <0.01, P <0.05), and the degree of peak reduction was greater for NIRA than for IRA. The comparison of IR and NIRA between Sm and D in AMI patients prompted us to conclude that in the anterior wall AMI group (except for the Sm in the anterior wall), basal segments of the anterior wall and inferior wall, Sm and D in the middle segment can distinguish between infarcted and non-infarcted myocardium (P <0.05). Sm and D in the inferior wall, anterior septum, posterior wall and middle septum in the inferior wall AMI group (Sm except the inferior wall AMI group) could differentiate between infarcted and non-infarcted myocardium (P <0.05). Conclusion Compared with normal subjects, Sm and D in AMI patients can not only distinguish normal, ischemic and necrotic myocardium from non-invasive, quantitatively, accurately and sensitively in the early stage of acute ischemia, but also evaluate myocardial ischemia and necrosis of IRA and NIRA, Provide bedside measurement, convenient and efficient treatment.