急性心肌梗塞早期冠状动脉再通对左室重塑和收缩功能的影响  

The effect of early coronary reperfusion on left ventricular remodeling and systolic function in patients with acute myocardial infarction

作　　者：杨跃进[1,2] 高润霖[1,2] 田军[1,2] 陈在嘉[1,2] 徐义枢[1,2] 陈纪林 姚康宝[1,2] 乔树宾 

机构地区：[1]中国医学科学院中国协和医科大学 [2]河南省人民医院心内科

出　　处：《中华内科杂志》1998年第4期242-246,共5页Chinese Journal of Internal Medicine

摘　　要：目的评价急性心肌梗塞（ＡＭＩ）早期冠状动脉（冠脉）再通对左室重塑和收缩功能的影响。方法８１例首次ＡＭＩ恢复期患者分成前、侧壁和下、后壁心肌梗塞（ＭＩ）的未通和再通各两组，与正常组（２５名）对比分析左室重塑和心功能变化，并对比再通和未通组的结果。结果（１）前、侧壁和下、后壁ＭＩ未通组左室舒张末容积（ＥＤＶ）、弧长（ＥＤＣ）、短轴（ＥＤＤ）、短／长轴比、圆球容积指数和收缩末容积（ＥＳＶ）均比正常组显著增加（Ｐ值分别＜００１～０００１）；射血分数（ＬＶＥＦ）均显著降低（Ｐ值均＜０００１），且ＥＤＶ、ＥＳＶ增加和ＬＶＥＦ降低在前、侧壁比下、后壁ＭＩ更明显（Ｐ值分别＜００５～０００１）；因而均有左室重塑（ＥＤＣ、ＥＤＶ增加和形状变圆）伴收缩功能降低，且在前、侧壁ＭＩ更明显。（２）前、侧壁和下、后壁ＭＩ再通与未通组相比，左室节段运动异常的范围、程度、ＥＤＤ、ＥＤＶ、ＥＳＶ均显著为低（Ｐ值分别＜００５～０００１），ＬＶＥＦ均显著为高（Ｐ值＜０００１和００５），且ＥＤＶ、ＥＳＶ和ＬＶＥＦ在再通组间差异均无显著性（Ｐ值均＞００５）。结论ＡＭＩ早期（６小时内）冠脉再通能缩小ＭＩ范围，防止左室重塑和扩大，保护?Objective To evaluate the effect of early coronary reperfusion on left ventricular remodeling and systolic function in patients with acute myocardial infarction (AMI). Methods Eighty one patients in convalescent stage of a first AMI were divided into four groups according to with or without successful coronary reperfusion after being treated within 6 hours after the onset: anterolateral AMI with reperfusion ( n =21), and without reperfusion ( n =20) inferoposterior AMI with reperfusion ( n =20) and without reperfusion ( n =20). By using left ventriculogram the parameters of left ventricular (LV) remodeling and systolic function in the four groups were analyzed and compared with those in a normal group ( n =25). The parameters in the two groups with reperfusion were also compared with those in the two groups without reperfusion. Results 1. In anterolateral and inferoposterior AMI groups without reperfusion the LV enddiastolic volume (EDV), circumference (EDC), dimension (EDD), minor to major axis ratio, sphericity index and end systolic volume (ESV) were all increased significantly ( P <0.01～0.001 respectively) when compared with those in normal group, while LV ejection fraction (LVEF) in the two groups were decreased significantly (both P <0.001). There were more significant increase in EDV and ESV and decrease in LVEF in the anterolateral AMI group than those in the inferoposterior AMI group ( P <0.05～0.001 respectively). It was indicated that LV remodeling had occurred in both groups without reperfusion as shown by increase in EDV, EDC and shperical change in LV shape as well as decrease in systolic function. 2. In both the anterolateral and inferoposterior AMI groups with reperfusion LV, EDV, EDD and ESV were smaller and the extent and severity of reginal wall motion abnormality significantly less than those in the two groups without reperfusion ( P <0.05～0 001 respectively), while LVEF in the two groups were significantly higher ( P <0.001 and 0.05), and there was no significa

关 键 词：心肌梗塞 冠状动脉再通 左室重塑 收缩功能 

分 类 号：R542.220.5[医药卫生—心血管疾病]