侧支循环在急性心肌梗死中作用  

The effect of collateral circulation on acute myocardial infarction

作　　者：徐立庆[1] 周旭晨[2] 栗印军[1] 

机构地区：[1]沈阳市第四人民医院心内科,沈阳110031 [2]大连医科大学附属第一医院心内科,辽宁大连116011

出　　处：《岭南心血管病杂志》2006年第1期28-31,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的了解急性心肌梗死发生时侧支循环对心肌的保护作用。方法急性心肌梗死患者50例,在急性心肌梗死发作3 d内行冠状动脉造影术,根据冠状动脉造影判断侧支循环的分级,将病人分为侧支良好组和侧支不良组,对比分析两组患者的冠状动脉造影资料和临床资料。结果侧支良好组21例,侧支不良组29例。侧支良好组的肌酸激酶峰值及心肌型肌酸激酶同工酶MB(CK-MB)的峰值分别为(1853±790) U／L和(137±43)U／L,明显低于侧支不良组肌酸激酶峰值及心肌型肌酸激酶MB(5203±2685)U／L和(380± 225)U／L,差异有统计学意义(P<0．05)。两组心电图比较,侧支良好组异常Q波的出现率为24％;侧支不良组为100％(P<0．05)。侧支良好组心电图ST段抬高的总和均值分别为(1．1±1．2)mV,侧支不良组为(2．6± 1．2)mV(P<0．05)。心脏超声检查侧支良好组28％的患者心室壁运动正常,而侧支不良组中心室壁运动正常者仅占3％(P<0．05);侧支良好组的左心室射血分数(0．54±0．08)明显高于侧支不良组(0．44±0．08),P< 0．05。侧支良好组心律失常发生率24％,心源性休克发生率5％和病死率0％,而侧支不良组分别为17％, 24％和24％,差异有统计学意义(P<0．05)。结论良好的侧支循环对急性心肌梗死心肌有保护作用,防止左心室功能下降,保持心肌功能的完整性。Objectives To identify the relationship between collaterals and clinical situation as well as the relation between collaterals and prognosis of patients by means of coronary angiography （CAG） and non-invasive ways, and to prove the protective effect of coronary collaterals as soon as acute myocardial infarction （AMI） happened. Methods The study group consisted of 50 patients undergone percutaneous transluminal coronary angioplasty （PTCA） within 3 days after onset of the first AMI. All patients were divided into two groups （A and B） on the basis of whether the collateral vascular was found during the coronary angiography. The materials of group A and group B in clinical and CAG were analyzed and compared. Results The levels of creatine kinase （CK） and CK-MB：in the patients with AMI, peak CK and peak CK-MB in group A were significantly lower than that in the group B[（1853±790）U/Lvs（5203± 2685）U/L,（137±43）U/L vs （380±225）U/L,P〈0.05）]. Electrocardiogram： Abnormal Q waves （24% vs 100%） were less frequently observed in the group A than in the group B, the sum of ST segment elevation tended to be lower in the group A than in the group B. Echocardiography： the left ventricular ejection fraction in the group A was significantly higher than in the group B [（54±8）% vs （44±8）%,P〈 0.05],the incidence of new wall motion abnormalities in the group A（72%） was lower than in the group B（97%）. The incidence of cardiogenic shock and the death in the group A（4.7% and 0%） was lower than in the group B. Conclusions The collateral circulation can protect the myocardium in AMI and prevent the decrease of left ventricular function.

关 键 词：急性心肌梗死 侧支循环 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]