急性Q波性和非Q波性心肌梗死后存活心肌及其对晚期血运重建术后心功能的影响  

Viable myocardium in patients with Q wave verses non-Q wave myocardial infarction and its effect on left ventricular function after late revascularization

作　　者：马礼坤[1,2] 余华[2] 冯克福[2] 陈鸿武[2] 黄向阳[2] 韩晓萍[2] 叶琪[2] 郑丽梅[2] 汪道文[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,武汉430030 [2]安徽省立医院心内科安徽省心血管病研究所,合肥230001

出　　处：《临床心血管病杂志》2009年第9期670-673,共4页Journal of Clinical Cardiology

基　　金：安徽省临床医学重点学科应用技术计划课题(No:05A020)

摘　　要：目的:比较急性Q波性心肌梗死(QMI)和非Q波性心肌梗死(NQMI)患者临床和冠状动脉病变特征以及梗死相关区域存活心肌的情况,并随访观察其对心肌梗死晚期血运重建术后心功能的影响。方法:连续收集121例急性心肌梗死(AMI)患者,分为QMI组(79例)和NQMI组(42例)。详细记录和分析所有患者的病史资料。于AMI后2周左右行经皮冠状动脉介入治疗,术前采用小剂量多巴酚丁胺超声负荷试验,检查梗死相关区域存活心肌的情况,并且于术前和术后6个月时常规超声心动图检查左室功能和室壁节段性运动障碍情况。随访6个月内主要心血管事件的发生率。结果:AMI前有心绞痛发作史者和冠状动脉病变血管的数量在NQMI组明显多于QMI组(P<0.05),而梗死相关部位平均管腔残余狭窄以NQMI组明显小于QMI组(P<0.05)。NQMI组中86%的患者有存活心肌,明显高于QMI组(61%)(P<0.01)。术后6个月随访,2组左室射血分数较术前明显提高,左室舒张末期及收缩末期容积指数、室壁运动积分均较术前明显降低(分别为P<0.05和P<0.01),以NQMI组更明显。结论:与QMI相比,NQMI患者有较多的存活心肌;心肌梗死后晚期血运重建能更有利于改善NQMI患者远期左室功能。Objective：To compare the clinical and angiographic distinctions as well as viable myocardium between Q wave and non-Q wave myocardial infarction,and its effect on left ventricular systolic function after late revascularization. Method：A total of 121 consecutive patients with acute myocardial infarction （AMI） were selected,and divided into the QMI group （n=79） and the NQMI group （n=42）. The data of clinical manifestation and angiogram were analyzed. All patients received successful percutanous coronary angioplasty （PCI） at about 2 weeks from AMI onset,and low-dose dobutamine echocardiogram was done to detect ischemic viable myocardium,and left ventricular function and wall motion abnormality were assessed with echocardiogram before PCI and 6 months after PCI. Result： In the NQMI group,more patients had angina before AMI,and more patients had multivessel coronary artery disease than the QMI group（P〈0.05）. Whereas the average residual stenosis of infarct related artery in NQMI group was lower than QMI group（P〈0.05）.Viable myocardium was more common in NQMI than in QMI （86% vs 61%,P〈0.01）. There were no significant differences of left ventricular ejection fraction （LVEF）,left ventricular end diastolic volume index （LVEDVI）,left ventricular end systolic volume index （LVESVI）,and wall motion score （WMS） between two groups at baseline before PCI（P〉0.05）. At six months after PCI,LVEF increased while LVEDVI,LVESVI,WMS decreased significantly in both groups compared with before,especially in NQMI group （P〈0.05 or P〈0.01）. Conclusion：Viable myocardium is more common in NQMI patient compared with QMI patient. Late revascularization can especially improve the late phase left ventricular systolic function in NQMI patient.

关 键 词：心肌梗死 存活心肌 血运重建术 

分 类 号：R542.22[医药卫生—心血管疾病]