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 张晓红 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,合肥市230001 [2]滁洲市二院心内科 [3]合肥市一院心内科 [4]安徽中医学院附一院心内科

出　　处：《中国分子心脏病学杂志》2004年第5期275-278,共4页Molecular Cardiology of China

基　　金：安徽省自然科学基金项目(编号:03043710);安徽省优秀青年基金资助

摘　　要：目的探讨急性前壁心肌梗死后,延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通,对心梗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波性心梗后病情稳定,发病10～21天冠脉造影证实左前降支完全闭塞者,依据是否接受成功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腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况.结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P＞0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P＞0.05).6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P＞0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P＜0.01,P＜0.05),且与成功PCI组相比差异具有显著性(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2%,但差异缺乏统计学意义(P＞0.05).结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大.延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生.Objective To （IRA） by percutanous coronary assess the effect of delayed intervention （PCI） on the late opening of the infarct-related artery left ventricular remodeling after acute anterior myocardial infarction. Methods Sixty-four patients with initial Q-wave anterior myocardial infarction and the infarct-related arteries were total occluded conformed by angiogram at 10 to 21 days after onset were divided into successful PCI group and control group （not receiving PCI or the IRA not re-opened）. Two-DE was performed at acute phase （about 3 weeks）, 2 and 6 months after onset VWMA scores, left ventricular ejection fraction （LVEF）, left ventricular end-diastolic and end-systolic volume indexes （LVEDVI and LVDSVI） were similar in 2 groups at acute phase and 2 months. There were no differences between acute phase and 2 months in did not changed at 6 months in each group compared with each group too. VWMA scores and LVEF acute phase and 2 months （P 〉0.05）. But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group （P 〈 0.01, P 〈 0.05） The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group （P〉0.05）. Conclusions Delayed opening of IRA in acute anterior myocardial infarction can prevent the late phase but not the early phase of left ventricular remodeling after AMI.

关 键 词：急性心肌梗死 经皮冠状动脉血运重建术 左室重构 

分 类 号：R542.22[医药卫生—心血管疾病]