高憲立2006-07-262018-07-112006-07-262018-07-112000http://ntur.lib.ntu.edu.tw//handle/246246/23447對於急性心肌梗塞的病患而言，左心室血栓為一常見的併發症。此併發症常可引起 週邊甚至腦部的栓塞。過去學者的研究指出，利用杜卜勒超音波心圖或彩色血流譜，其 描繪出不正常的心室血流途徑，比一般的臨床評估或超音波心圖檢查，更能預測病人產 生左心室血栓的機率，可以作為抗凝血劑治療與否的參考依據。近年來，利用杜卜勒能 量超音波心圖產生的超音波散射粒子的影像，已經可以用粒子循跡圖的方式追蹤血液流 動的情形。此種超音波能量轉換的粒子循跡圖對於低速的血流，能以較高的掃瞄圖速， 描繪出血液在心室內流動的軌跡，其敏感度也勝過以前使用的彩色血流譜。 本研究欲探測的假說，乃是在急性心肌梗塞後，欲預測左心室血栓形成，不正常的左心 室內血流空間分佈較臨床資料及傳統的雙面超音波心圖變項更具準確度。我們選取79 位前壁心肌梗塞病患在72 小時內及出院前施行二次超音波心圖檢查，若左心室心尖部 出現旋轉的渦流被視為不正常。以杜卜勒能量超音波心圖(Power Doppler Echocardiography)檢查，移動的血流可以產生粒子循跡影像，判定心室內血流軌跡。在 有些左心室運動失全的區域，會顯現區隔性的渦流，表示血液在此有遰留的現象。此篇 研究顯示以此種粒子循跡影像來判定左心室內血栓形成，較傳統的雙面及彩色超音波心圖變項更具準確度。With regard to the predictive accuracy for left ventricular thrombosis after myocardial infarction, the abnormal spatial distribution of left ventricular flow is superior to conventional clinical and two-dimensional echocardiographic variables. Tracking the speckle patterns produced by moving blood has been recently validated with power Doppler ultrasonic imaging. To evaluate the ability of power Doppler-derived speckle tracking image in delineating abnormal left ventricular flow patterns and in predicting left ventricular thrombosis after anterior wall myocardial infarction, echocardiography was prospectively performed in 79 patients within 72 h after anterior wall myocardial infarction onset and repeated before discharge. The apical rotating flow pattern in color flow map was recognized as abnormal. By power Doppler echocardiography, the moving blood could generate speckle tracking images to delineate the intraventricular flow. A swirling flow pattern indicating the compartmentalization of left ventricular blood flow with some blood stagnant in the apical dyssynergic area was identified. The flow pattern shown by the speckle tracking image was superior to the color-flow map in correlating with left ventricular thrombosis. It implicated that the more the detail in which we can describe the blood flow pathway, the more information we can realize.application/pdf32719 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科心肌梗塞局部血流血栓粒子循跡杜卜勒能量超音波myocardial infarctionregional blood flowthrombusspeckle-trackingpower motion imagereporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/23447/1/892314B002069.pdf