急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响  

Effects of delayed opening of infarct-related artery on late left ventricular remodeling in patients with acute anterior myocardial infarction

作　　者：马礼坤[1] 余华[1] 黄向阳[1] 褚俊[1] 冯克福[1] 李世光[2] 张晓红[3] 邵正斌[4] 丁晓梅[1] 严激[1] 顾统元[1] 

机构地区：[1]安徽省立医院心内科,合肥230001 [2]滁州市第二人民医院心内科 [3]合肥市第一人民医院心内科 [4]安徽中医学院附属第一医院心内科

出　　处：《中华心血管病杂志》2005年第4期328-331,共4页Chinese Journal of Cardiology

基　　金：安徽省自然科学基金(03043710);安徽省优秀青年基金(04043054)

摘　　要：目的探讨急性前壁心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)使梗死相关动脉(IRA)开通对AMI晚期左室重构的影响.方法选择64例急性前壁、前间壁及广泛前壁Q波性AMI后病情稳定,发病2～14天,平均(9.1±2.3)天冠状动脉造影证实左前降支完全闭塞者,依据是否成功行PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室大小、左室功能和室壁活动异常情况,并观察6个月期间心力衰竭事件的发生情况.结果 AMI后2个月两组左室射血分数、左室收缩末期容积指数、左室舒张末期容积指数和室壁活动异常积分与急性期相比差异无统计学意义,急性期和2个月时两组上述各指标之间差异也无统计学意义.6个月时两组左室射血分数和室壁活动异常积分与急性期和2个月相比差异无统计学意义,但对照组左室舒张末期容积指数和左室收缩末期容积指数较急性期明显增大(P<0.01, P<0.05),且与成功PCI组相比差异有统计学意义(P<0.01, P<0.05).6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组为2%,但差异无统计学意义.结论急性前壁AMI后IRA延迟开通能明显减少AMI后晚期的左室重构,而对AMI后早期左室重构的影响不大.延迟PCI可能有利于减少AMI后远期心力衰竭事件的发生.Objective To assess the effect of delayed opening of the infarct-related artery (IRA) by percutanous coronary intervention (PCI) on the late left ventricular remodeling after acute anterior myocardial infarction (AAMI). Methods Sixty four patients with initial Q-wave AAMI and with the total occluded IRA conformed by angiogram at 9.1±2.3(2 ~ 14)days after the onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re-opened). Two-D echocardiogram was performed at acute phase (about 3 weeks), 2 and 6 months after onset of AAMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up.Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) were similar in 2 groups at acute phase and 2 months after the onset of AAMI. There were no differences between the parameters above at acute phase and 2 months in each group too. VWMA scores and LVEF did not changed significantly at 6 months in each group compared with those at acute phase and 2 months (P>0.05). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than those in the control group (P<0.01, P<0.05). The rate of congestive heart failure events was 19% in control group and 2.0% in successful PCI group (P>0.05) respectively.Conclusions Delayed opening of IRA in AAMI could prevent the late phase but not the early phase of left ventricular remodeling after AMI.

关 键 词：梗死相关血管 晚期 开通 延迟经皮冠状动脉介入治疗 左室收缩末期容积 急性前壁心肌梗死 左室射血分数 舒张末期容积 急性前壁AMI 死后 梗死相关动脉 冠状动脉造影 室壁活动 心力衰竭 早期左室重构 急性期 超声心动图 统计学 

分 类 号：R542.22[医药卫生—心血管疾病] R22[医药卫生—内科学]