不同介入治疗方案对急性心肌梗死患者心功能及心肌组织灌注的影响  

Effects of different percutaneous coronary intervention on ventricular function and myocardial tissue reperfusion in acute myocardial infarction

作　　者：许丹[1] 尚小明[1] 姜玉如[1] 纪征[1] 卢峰[1] 姜玉凤[1] 孙淑娴[1] 张宇[1] 张春来[1] 

机构地区：[1]唐山市工人医院心内一科,河北唐山063000

出　　处：《中国急救医学》2006年第8期576-578,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的对接受不同介入治疗(PC I)方案患者心功能及心肌组织血流灌注的研究,探讨急性心肌梗死(AM I)患者行PC I最佳时机和方法。方法入选69例行介入治疗AM I患者,分为直接PC I组(A组)、易化联合PC I组(B组)、延迟PC I组(C组)三组。术后第7、30天行心脏超声及99mTc-甲氧基异丁基异腈(M IB I)心肌灌注断层显像(SPECT),评价心功能及心肌组织灌注。结果①三组患者扩张后即刻造影结果显示,管腔残余狭窄率<10%,手术成功率100%。②第30天时A、B两组左心室收缩、舒张末容积指数(LVESVI、LVEDVI)、左心室射血分数(LVEF)均优于C组。③第30天时放射性缺损面积(M IA)A、B两组低于C组,A、B两组心肌组织血流灌注均优于C组。④住院期间A组1例患者发生急性血栓形成,三组患者无死亡病例,随访期间C组1例患者死于心功能衰竭。结论直接PC I、易化PC I可显著提高AM I患者的近期心肌组织血流灌注,缩小心肌梗死面积,保护心功能;延迟PC I宜早期进行。Objective To evaluate the effects of different pereutaneous coronary intervention on ventricular function and myocardial tissue reperfusion in acute myocardial infarction （ AMI ）. Methods Sixty nine patients with first AMI were divided into three groups according to their choices ： primary PCI （ group A, n = 23 ） ; facilitated PCI （ group B, n = 21 ） ; delay PCI （ group C, n = 25 ）. 7 days and One month after PCI,^99mTc - MIBI SPECT were performed to detect myocardial tissue perfusion and ultrasound were used to evaluate ventricular function. All patients were followed up for 12 months. Results （1）Patients with remain stenosis 〈 10% after agiography. （2）Ventricular function （ EDVI and LVEF ） was decreased in group A and B than in group C, LVEF was significantly increased in group A and B than in group C （ P 〈 0.05 ）. （3）Myocardial infarction area （ MIA ） was lower in group A and B than in group C （ P 〈 0. 05}. （4）No case was dead in three groups. Conclusions （1）Primary PCI and facilitated PCI have significantly effects, including increased myocardial tissue reperfusion and limiting infarct area , protecting ventrieular function. （2）Delay PCI should be done as early as impossible if condition was permitted.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 心肌组织再灌注 易化PCI 

分 类 号：R542.22[医药卫生—心血管疾病]