急性心肌梗死冠状动脉再通后血流缓慢的临床意义  

Clinical Significance of Slow-flow Phenomenon Observed on Angiography After Coronary Artery Recanalization in Patients With Acute Myocardial Infarction

作　　者：张瑞岩[1] 沈卫峰[1] 张建盛[1] 张大东[1] 徐志红[1] 胡健[1] 张宪[1] 郑爱芳[1] 

机构地区：[1]上海第二医科大学附属瑞金医院

出　　处：《中国循环杂志》1998年第1期7-9,共3页Chinese Circulation Journal

摘　　要：目的：评价急性心肌梗死（ＡＭＩ）冠状动脉再通后血流缓慢的临床意义。方法：５０例急性心肌梗死患者行静脉溶栓或经皮冠状动脉腔内成形术（ＰＴＣＡ），使梗死相关冠状动脉再通。相关冠状动脉血流心肌梗死溶栓试验（ＴＩＭＩ）计帧法示１５例血流缓慢（血流缓慢组），３５例血流正常（血流正常组）。结果：左心室造影血流缓慢组较血流正常组收缩末期容量增大，射血分数减低。血流缓慢组９０分钟后抬高ＳＴ段总和回落小于血流正常组，血流缓慢组ＱＲＳ波群积分和肌酸激酶峰值及其距发病时间大于血流正常组。住院期间血流缓慢组心脏事件发生率（４６．７％）显著高于血流正常组（８．６％，Ｐ＜０．０５）。出院前超声心动图检查显示，血流缓慢组收缩末期容量大于血流正常组，而射血分数低于血流正常组。结论：ＡＭＩ患者相关冠状动脉再通后血流缓慢提示心肌梗死面积大、心功能较差、预后不良。? Objective:To assess the clinical significance of slow-flow phenomenon observed on angiography after coronary artery recanalization in patients with acute myocardial infarction(AMI) Methods:Coronary flow of the infarctrelated artery (IRA) was evaluated with thrombolysis in myocardial infarction trial(TIMI)frame count method in 50 patients with AMI after successful recanalization by thrombolysis or percutaneous transluminal coronary angioplastyCoronary flow was slow in 15 (group 1) and was normal in 35 patients (group 2) Results:Left ventriculography 90 min after thrombolysis showed that left ventricular endsystolic volume was significantly larger and ejection fraction was lower in group 1 than in group 2(both p<005)QRS score and peak creatine kinase were significantly higher in group 1(both p<005 vsgroup 2)The sum of ST segment elevation decreased less but the time to peak creatine kinase from the onset of symptoms was longer in group 1The incidence of cardiac event during hospitalization was higher in group 1(467%)than in group 2(86%,p<005)Predischarge echocardiography showed that left ventricular endsystolic volume was significantly larger and ejection fraction was lower in group 1(both p<005 vsgroup 2) Conclusion:The slowflow phenomenon in patients with AMI after successful recanalization may indicate larger infarct site,lower left ventricular function and worse prognosis

关 键 词：心肌梗死 冠状动脉造影 预后 AMI PTCA 血流缓慢 

分 类 号：R542.220.7[医药卫生—心血管疾病]