心肌梗死择期经皮冠状动脉介入治疗对左心室重构和收缩功能的影响  

Effect of Elective Percutaneous Coronary Intervention on Left Ventricular Remodeling and Systolic Function in Patients After Myocardial Infarction

作　　者：华倚虹[1] 杨跃进[1] 高润霖[1] 秦学文[1] 乔树宾[1] 姚民[1] 徐波[1] 刘海波[1] 袁晋青[1] 陈纪林[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病诊治中心,北京市100037

出　　处：《中国循环杂志》2006年第4期253-256,共4页Chinese Circulation Journal

摘　　要：目的:评价心肌梗死恢复期经皮冠状动脉介入治疗对左心室重构和收缩功能的影响。方法:将成功经皮冠状动脉介入治疗后又有造影复查的380例冠心病患者分为2组,①心肌梗死组224例,其中前壁梗死者106例,下壁梗死者102例,其它部位梗死者16例;介入治疗时梗死相关冠状动脉闭塞者118例,非闭塞者105例,梗死相关冠状动脉无法判断者1例。②非心肌梗死组156例。结果:380例中冠状动脉单支、双支和三支病变者占28％、37％和35％。①非心肌梗死组经皮冠状动脉介人治疗前、后左心室大小和收缩功能参数无显著变化,且在正常范围。②心肌梗死组经皮冠状动脉介入治疗前左心室舒张末容积(LVEDV)及指数(LVEDVI)、收缩末容积(LVESV)及指数(LVESVI)比非心肌梗死组均已显著增大(P均<0．001),左心室射血分数(LVEF)和左心室收缩末压(LVESP)均显著降低(P均<0．001);经皮冠状动脉介入治疗后LVESV、LVESVI均比治疗前显著降低(P均<0．001),每搏量(SV)及其指数(SVI)、LVEF、LVESP均显著提高(P<0．05-0．001);LVESVI降低和LVEF升高的程度比非心肌梗死组更显著(P<0．05～0．001);且在前壁和下壁心肌梗死患者间均无显著差异,疗效相当。③经皮冠状动脉介入治疗前梗死相关动脉闭塞和非闭塞患者,经皮冠状动脉介入治疗后LVEF均显著提高(P均<0．001),而LVESV、LVESVI仅在梗死相关动脉闭塞者显著降低(P均<0．05)。结论:急性心肌梗死患者恢复期已发生左心室重构伴收缩功能减低,择期经皮冠状动脉介入治疗可有效逆转左心室重构,提高左心室收缩功能。Objective： To evaluate the effect of elective percutaneous coronary intervention （PCI） on left ventricular remodeling and systolic function at convalescent stage of acute myocardial infarction. Methods ： Retrospective analysis was done among 380 patients with coronary heart disease who had follow-up angiography after successful elective PCI. 224 with a history of myocardial infarction （MI）were assigned to MI group, and 156 with only angina pectoris to non-MI group （control）. Results ： ①In non-Ml group, the variables of left ventricular remodeling and systolic function had no significant change after PCI（P〉0. 05）. They were in the normal range. ②Before PCI, left ventficular（LV） end-diastolic, end-systolic volume and their indexes（LVEDV,LVEDVI,LVESV,LVESVI） were significantly increased, but LV ejection fraction and end-systolic pressure （ LVEF and LVESP） were significantly decreased （ P 〈 0. 001 ） in MI group compared with non-Ml group（ P 〈 0. 001 ）, During the follow-up LVESV,LVESVI were significantly lowered （P 〈0. 001 ）, and SV, SVI, LVEF, LVESP were significantly increased（P 〈0. 05-0. 001 ）as compared to the baseline, with LVESVI and LVEF more significant in the MI group than in the non MI group （P 〈 0. 05-0. 001 ）. There was no significant difference between anterior and inferior myocardial infarction subgroups （P 〉0. 05）. ③LVEF was improved after PCI in both infarction-related artery （IRA） occluded group and non-occluded groups （P 〈 0. 001 ）. LVESV and ESVI were significantly decreased only in the IRA occluded group（P 〈 0. 05）. Conclusion： There exist left ventricular remodeling and impaired systolic function in MI patients at convalescent stage. Elective PCI can effectively reverse left ventricular remodeling and improve systolic function.

关 键 词：心肌梗塞 经皮冠状动脉介入治疗 左心室重构 收缩功能 

分 类 号：R541.4[医药卫生—心血管疾病]