侧支循环对前壁心肌梗死患者左室功能及预后的影响  

Effects of coronary collateral circulation on left ventricular function and clinical outcome in patients with anterior wall myocardial infarction

作　　者：龙娟[1] 衣为民[1] 彭长农[1] 李忠红[1] 王丽丽[1] 

机构地区：[1]深圳市孙逸仙心血管医院内科,广东深圳518001

出　　处：《中国医学工程》2005年第4期344-347,共4页China Medical Engineering

摘　　要：目的分析侧支循环对前壁心肌梗死患者左室整体收缩功能、并发症及生存率的影响,探讨影响侧支循环的可能预测因素。方法该院近10年因前壁心肌梗死而行冠脉动脉造影示前降支TIMI血流0-1级者且院内存活并行冠脉血运重建术(PTCA、STENT或CABG术)者138例,将冠状动脉影像学示前降支无侧支循环或只有局限于小分支的侧支循环者分为第1组(n=86),前降支主干部分或完全经侧支循环显影者分为第2组(n=52)。比较两组的临床情况、左室射血分数,并进行定期随诊观察临床预后。结果侧支循环与性别、年龄、糖尿病史无相关性,侧支循环良好组完全闭塞性病变和多支病变发生率增高,梗塞前心绞痛史和非Q波心肌梗死在侧支循环良好的患者更多见;且左室整体收缩功能更好;在随诊中侧支循环良好的患者左室收缩功能有进一步改善;侧支循环良好者院内并发症发生率明显降低;两者在死亡率及临床心脏事件上侧支循环良好者均较低。结论侧支循环良好的前壁心肌梗死患者左室收缩功能恢复更好,长期死亡率及患病率更低,多支病变、慢性完全闭塞病变、有梗塞前心绞痛史的患者存在良好侧支循环的可能更大。[Objective] To study the influence of coronary collateral circulation on global left ventricular contractile function, complication and survival rate in patients with anterior wall myocardial infarction. The possible predictive factors to coronary collateral circulation are also evaluated. [Method] There were 138 cases of in-hospital survivors of myocardial infarction admitted to our hospital, who revealed TIMI 0-1 grade flow at anterior descending artery angiographicaUy and received coronary revascularization. The 138 patients were divided into two groups according to angiographic coronary collateral circulation as follow： none or filling limited to side branches （group 1, n= 86） and partial or complete filling of the left anterior descending artery （group 2, n=52）. The clinical characteristics and left ventricular ejection fraction were compared between the two groups. The clinical outcome was observed through long-term follow-up. [Result] The groups were similar in age, sex and the presence of diabetes mellitus. Higher incidences of multi-vessel lesions and total occlusion were found in Group 2. The incidence of preceding angina pectoris, none Q-ware myocardial infarction was higher in group2. But the in-hospital complication was lower in group 2. The global left ventricular function was better and it revealed further improvement during follow-up in group 2. The mortality and cardiac events were much lower in group 2. [Conclusion] Coronary collateral circulation has protective effects on left ventricular function to patients suffering from anterior wall myocardial infarction. It alsodemonstrates important influence on long-term mobility and mortality in patients with anterior wall myocardial infarction. The symptom as preceding angina pectoris may be a predictor of collateral circulation. Patients with multivessel lesion and total occlusion have higher possibility of well-developed collaterals.

关 键 词：前壁心肌梗死 侧支循环 

分 类 号：R543.31[医药卫生—心血管疾病]