直接经皮冠状动脉腔内成形术与溶栓治疗对限制急性心肌梗死面积的影响  

Limitation of infarct size after primary angioplasty compared with intravenous thrombolysis in acute myocardial infarction

作　　者：陈步星[1] 王伟民[1] 蒋宝琦[1] 徐成斌[1] 赵红[1] 魏娟[2] 张秀[3] 卢明瑜[1] 刘健[1] 高伯山[4] 岳明纲[4] 

机构地区：[1]北京医科大学人民医院心内科,100044 [2]西安电力中心医院 [3]北京二龙路医院 [4]北京医科大学人民医院核医学科,100044

出　　处：《中国介入心脏病学杂志》2000年第2期62-65,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的　比较直接经皮冠状动脉腔内成形术 (PTCA)与溶栓治疗对急性心肌梗死 (AMI)患者梗死面积和左心室功能的影响。方法　对 47例AMI患者经PTCA术和静脉溶栓治疗患者行硝酸异山梨醇酯99mTc MIBI心肌断层显像定量分析 ,测定心肌梗死的面积 ;急性心肌梗死后 10～ 14天行超声心动图检查测定左心室射血分数。结果　直接PTCA术患者心肌梗死面积绝对值和梗死面积占左心室的百分数均小于溶栓再灌注组 [分别为 (10 5± 12 5 )cm2 vs(49 0± 2 8 3)cm2 ,P <0 0 5 ;(9 1±13 6 ) %vs(2 6 6± 15 5 ) % ,P <0 0 5 ],溶栓再灌注组则小于溶栓未再灌注组 [分别为 (49 0± 8 3)cm2vs(95 7± 5 9 3)cm2 ,P <0 0 5 ;(2 6 6± 15 5 ) %vs(5 1 9± 2 1 1) % ,P <0 0 1) ]。直接PTCA组左心室射血分数高于溶栓再灌注组 [(6 4 2± 8 3) %vs(5 4 3± 12 5 ) % ,P <0 0 5 ],而溶栓再灌注组高于未再灌注组 [(5 4 3± 12 5 ) %vs(43 2± 7 0 ) % ,P <0 0 1]。结论　AMI直接PTCA术与静脉溶栓治疗比较 ,能最大限度缩小梗死面积 ,更好地保护心功能。Objective To compare the effects of primary coronary angioplasty with thrombolysis after acute myocardial infarction (AMI) on myocardial infarct size and left ventricular function Methods Forty seven patients with the first AMI were performed either primary coronary angioplasty or intravenous thrombolysis All AMI patients were divided into three groups,15 patients with primary angioplasty (group A), 19 with successful reperfusion group (group B) and 13 non reperfusion group (group C) Ten days after AMI,myocardial infarct size was taken by quantitative technetium 99m sestamibi single photon emission computed tomography combined with isosorbide dinitrate infusion Cardiac function (left ventricular ejection fraction, LVEF) was assessed by echocardiography during 10～14 days after AMI Results The myocardial infarct size and LVEF in group A, Group B and group C were significiantly different The absolute and relative values of infarct size of group A were smaller than those of group B [(10 5±12 5)cm 2 vs (49 0±28 3)cm 2, P <0 05; (9 1±13 6)% vs (26 6±15 5)%, P <0 05, respectively], and group B were smaller than group C [(49 0±8 3)cm 2 vs (95 7±59 3)cm 2, P <0 05; (26 6±15 5)% vs (51 9±21 1)%, P <0 01, respectively] The LVEF of group A was higher than that of group B [(64 2±8 3)% vs (54 3±12 5)%, P <0 05], and group B was higher than group C [(54 3±12 5)% vs (43 2±7 0)%, P <0 01] Conclusions In patients with acute myocardial infarction, primary angioplasty results in a smaller infarct size and a better preserved cardiac function compared with patients receiving intravenous thrombolysis

关 键 词：心肌梗死 血管成形术 溶栓疗法 断层摄影术 

分 类 号：R542.220.5[医药卫生—心血管疾病]