急性心肌梗死早期左室重构与发病时间  

Observation on left ventricular remodeling in acute myocardial infarction

作　　者：张水旺[1] 李丽[1] 郭文玲 王陆建 阎晓梅 张承刚 

机构地区：[1]山西医科大学第一医院

出　　处：《中华内科杂志》1999年第2期107-109,I003,共4页Chinese Journal of Internal Medicine

基　　金：山西省归国留学人员科研基金

摘　　要：目的采用心肌静息门控单光子发射计算机体层摄影术（ＧＳＰＥＣＴ）研究了急性心肌梗死（ＡＭＩ）早期左室的重构特点。方法ＡＭＩ患者３７例，根据发病时间分作四个亚组，第一亚组（１６例），第二亚组（７例），第三亚组（１１例）和第四亚组（３例），患者发病时间分别为≤３小时，＞３小时～≤６小时，＞６小时～≤１２小时和＞１２小时。患者入院后即注射显影剂９９ｍ锝甲氧基异丁基异腈，２小时后采用双探头ＧＳＰＥＣＴ系统采集心肌显像资料，由程序自动处理并计算左室舒张末容积（ＥＤＶ），左室收缩末容积（ＥＳＶ），和左室射血分数（ＬＶＥＦ），并计算每搏搏出量（ＳＶ）。结果第一至第四亚组，ＥＤＶ：分别为（９８５±３１９）ｍｌ，（９９４±５５６）ｍｌ，（１２８１±５５１）ｍｌ和（１４００±２５３）ｍｌ；ＥＳＶ：分别为（５７０±３０９）ｍｌ，（５５１±４０３）ｍｌ，（７７４±３９８）ｍｌ和（８１３±２６０）ｍｌ。ＳＶ：分别为（５７０±３０９）ｍｌ，（５５１±４０３）ｍｌ，（７７４±３９８）ｍｌ和（８１３±２６０）ｍｌ。ＬＶＥＦ：分别为（４４６±１３１）ｍｌ，（４９７±１３１）ｍｌ，（４２?Objective After an acute myocardial infarction (AMI), there will be regional dilation and global remodeling of the infarcted left ventricle. This study was aimed to observe the features of the ventricular remodeling after AMI. Methods Based on the time of onset of the symptoms, 37 patients (pts) with AMI were divided into 4 groups. The time of onset of AMI for group 1 (16 pts), group 2 (7 pts), group 3 (11 pts) and group 4 (3 pts) was ≤3 hours (hrs), >3 hrs～≤6 hrs, >6 hrs～≤12 hrs and >12 hrs respectively. The size of the left ventricle in all the patients were analysed with resting myocardial gated SPECT (GSPECT). Tc 99m MIBI was infused at admission and data of GSPECT were collected 2 hours later following the infusion. End diastolic volume (EDV), end systolic volume (ESV) and LVEF were shown by the system. Stroke volume (SV) was then calculated. Results EDV for group 1 to 4 was (98.5±31.9)ml, (99.4±55.6)ml, (128.1±55.1)ml and (140.0±25.3)ml, respectively. ESV for group 1 to 4 was (57.0±30.9)ml, (55.1±40.3)ml, (77.4±39.8)ml and (81.3±26.0)ml, respectively. SV for group 1 to 4 was (57.0±30.9)ml, (55.1±40.3)ml, (77.4±39.8)ml and (81.3±26.0)ml, respectively. LVEF for group 1 to 4 was (44.6±13.1)ml, (49.7±13.1)ml, (42.8±13.5)ml, and (42.7±8.6)ml, respectively. In pts with anterior infarction, EDV, ESV and SV after 6 hrs of the onset of AMI were greater than those in pts with in 6 hrs of the onset. It was the same in pts with inferior infarction. Conclusion It is suggested that the left ventricular size increased in 3 hrs after AMI. Following the initial dilation of left ventricle, EDV, ESV and SV did not change significantly with in 6 hrs, but then increased gradually after 6 hrs from the onset of the symptoms. The early and significant dilation of left ventricle after AMI may be one of the risk factors of severe cardiac events.

关 键 词：心肌梗塞 GSPECT 左室重构 

分 类 号：R542.220.6[医药卫生—心血管疾病] R541.904[医药卫生—内科学]