急性心肌梗塞静脉溶栓治疗后冠状动脉再通对左心功能的影响  

Effect of coronary reflow after intravenous thrombolysis on left ventricular function in patients with acute myocardial infarction/

作　　者：胡正清[1] 余枢[1] 米世簪[1] 曾和松[1] 郭小梅[1] 

机构地区：[1]同济医科大学附属同济医院

出　　处：《中国危重病急救医学》1997年第3期166-167,共2页Chinese Critical Care Medicine

摘　　要：目的：研究急性心肌梗塞（ＡＭＩ）静脉溶栓治疗后冠状动脉（冠脉）再通对左心功能的影响。方法：以２４例ＡＭＩ患者接受尿激酶（ＵＫ）静脉溶栓治疗为研究对象，再通组１４例，未通组１０例，于发病后３～４周在进行选择性冠脉造影或经皮穿刺冠脉内成形术（ＰＴＣＡ）的同时行Ｘ线左心室造影。结果：再通组射血分数（ＬＶＥＦ）明显高于未通组（Ｐ＜０．０５）；室壁异常活动积分未通组明显高于再通组（Ｐ＜０．０１），其中室壁瘤发生率再通组显著低于未通组，分别为７．１４％与３０．００％（Ｐ＜０．０５）。结论：监测ＬＶＥＦ及室壁局部运动是判断ＡＭＩ时溶栓治疗使梗塞区冠脉再通效果的有效指标；ＡＭＩ后及时有效的静脉溶栓治疗可缩小梗塞面积，改善左心功能，对改善ＡＭＩ患者的近期预后有十分重要的意义。bjective:To determine the effect of coronary reflow on left ventricular function after thrombolytic therapy for acute myocardial infarciton (AMI).Methods:The subjects of this study were 24 patients with AMI,who were divided into reperfusion group(n=14) and nonreperfusion group(n=10).Selected coronary angiograph and percutaneous transluminal coronary angioplasty (PTCA) were performed simultaneously with left ventriculograph 3￣4 weeks after infarction.Results:It was showed that left ventricular ejection fraction(LVEF) was significantly higher in reperfusion group than that in nonreperfusion group ( P <0 05),while left ventricular wall motion score was significantly lower in reperfusion group than that in nonreperfusion group( P <0 01).Furthermore,incidences of ventricular aneurysm were 7 14% in reperfusion group and 30 00% in nonreperfusion group,respectively,and the difference was statistically significant( P <0 05).Conclusions:Our data suggest that LVEF and ventricular wall motion score are useful parameters to evaluate coronary reperfusion after intravenous thrombolysis .Early use of thrombolytic therapy may play an important role in diminishing the infarct size and improving left ventricular function as well as outcome in patients with AMI.

关 键 词：心肌梗塞 溶栓疗法 心功能 

分 类 号：R542.220.5[医药卫生—心血管疾病]