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目的 该文旨在探讨急性心肌梗塞后二尖瓣返流的发生机制。方法 用彩色多普勒超声对９１ 例急性首次心梗入院３ 天内患者按半定量法测定二尖瓣返流。结果 发现伴二尖瓣返流患者左室容积大、球形度大、下壁室壁异常运动积分高。亚组分析发现在前壁梗塞患者中也有类似表现；而在下壁梗塞的患者中，返流组的下壁室壁异常运动积分高，而其它指标差异均无显著意义。Ｌｏｇｉｓｔｉｃ 逐步回归分析发现左室舒张末期球形度和下壁室壁异常运动积分是二尖瓣返流的独立相关因素。结论 左室球形度增大，使乳头肌向两侧移位，以及乳头肌附近的心室壁梗塞或缺血导致的运动障碍是心梗急性期二尖瓣返流的重要机制。
Objective This paper aims to investigate the mechanism of mitral regurgitation after acute myocardial infarction. Methods The color Doppler ultrasound was used to determine the mitral regurgitation in 91 patients with acute primary myocardial infarction within 3 days after admission. The results showed that patients with mitral regurgitation had a large left ventricular volume, large sphericity, and abnormal wall motion in the inferior wall. A subgroup analysis found similar findings in patients with anterior wall infarction; in patients with inferior wall infarction, an abnormal motor score was significant in the inferior wall of the regurgitant group, with no significant difference in other measures. Logistic stepwise regression analysis showed that left ventricular end-diastolic sphericity and inferior wall motion abnormalities were independent correlates of mitral regurgitation. CONCLUSIONS: Increased left ventricular diameter, displacement of the papillary muscle to both sides, and ventricular wall infarction near the papillary muscle or ischemic movement disorders are important mechanisms of mitral regurgitation in acute myocardial infarction.