急性心肌梗死直接冠状动脉介入术后心肌灌注的评价及其对近期预后的影响  

Change of myocardial perfusion after direct percutaneous coronary intervention in patients with acute myocardial infarction and its effect on short-term clinical prognosis

作　　者：焦占全[1] 张梅[1] 李广平[1] 黄体钢[1] 马金萍[1] 尹力[1] 

机构地区：[1]天津医科大学第二医院心脏科,300211

出　　处：《中国心血管杂志》2008年第4期262-264,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的研究急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(d-PCI)后心肌灌注的主要影响因素及其对近期预后的影响。方法联合TIMI计帧分级(CTFC)与ST段的回落(STR)评价心肌灌注,并依此分为心肌灌注良好和灌注不良两组。观察两组患者的临床特点和随访6个月心室功能和主要心脏不良事件(MACE)。结果前壁梗死、IRA重建时间长是心肌灌注不良的独立危险因素。术后1周、1个月灌注不良组LVEF低于灌注良好组,而节段运动比率灌注不良组高于灌注良好组。两组患者PCI术后1个月左室收缩功能均较前改善,LVEF增加。随访6个月累计MACE、心力衰竭(心衰)的发生率灌注不良组高于灌注良好组(均P<0.05)。结论IRA重建时间与心肌灌注显著相关;心肌灌注显著影响AMI患者的心功能,灌注不良者近期MACE发生率高。Objective To investigate the main influencing factors of myocardial tissue perfusion and its influence on short-term prognosis in patients with ST-elevation acute coronary infarction （STEAMI） who achieved TIMI grade 3 flow after direct percutaneous coronary intervention（d-PCI）. Methods Cohort study method was used and 106 patients with primary STEAMI were recruited. All patients were underwent d-PCI and the forward TIMI grade 3 flow of infarct-related artery （IRA） was achieved, corrected TIMI frame count （CTFC） and ST-segment elevation resolution （STR） were used to evaluate myocardial perfusion. Patients were divided into two groups ： normal perfusion group and poor perfusion group. The baseline clinic characteristics were observed and ventricular function and major adverse cardiovascular events （MACE） were compared during 6 months＇ follow-up. Results Anterior myocardial infarction and delayed revascularization of IRA were the independent risk factors for poor myocardial perfusion. There were significant differences between two groups in left ventricular ejection fraction （LVEF） and the ratio of segmentation movement at 1 week and 1 month after procedure （ all P 〈 0. 05）. Compared with normal group, LVEF was lower and the ratio of segmentation movement was higher in poor perfusion group. LVEF was increased at 1 month after PCI in both groups than before. The incidences of MACE and heart failure at 6 months （both P 〈 0. 05） were higher in poor perfusion group than those in normal perfusion group. Conclusion The time to undergo revascularization of IRA in patients with STEAMI is significantly correlated with myocardial perfusion, and the heart function is greatly influenced by myocardial perfusion. Patients with poor perfusion have higher incidence of MACE.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R542.22[医药卫生—心血管疾病]