易化经皮冠状动脉介入治疗对急性心肌梗死后心室重构的阻抑作用  

Effect of facilitated percutaneous coronary intervention on ventricular remodeling in patients with acute myocardial infarction

作　　者：刘君[1] 傅向华[2] 薛玲[2] 吴伟力[2] 李世强[2] 谷新顺[2] 

机构地区：[1]河北医科大学第一医院心内二科,石家庄050031 [2]河北医科大学第二医院心内科干部病房

出　　处：《临床心血管病杂志》2012年第5期348-351,共4页Journal of Clinical Cardiology

摘　　要：目的:通过平衡法核素心室造影(ERNA)方法,对比评价溶栓、经桡动脉入径直接经皮冠状动脉介入治疗(PCI)和易化PCI对老年急性心肌梗死(AMI)患者心室重构的阻抑作用。方法:选择发病10h内的首次急性前壁ST段抬高型心肌梗死患者143例,随机分为直接PCI组71例和易化PCI组72例,另选择同期入院且一般临床资料匹配,但仅行溶栓治疗的70例患者为溶栓组。3组患者分别于AMI后1周、28周行ERNA,测定左室收缩功能参数及反常容积指数(PVI),随访28周内主要恶性心脏事件(MACE)的发生率。结果:①直接PCI组在PCI前梗死相关动脉(IRA)开通率明显低于溶栓组和易化PCI组(8.45%:31.43%,χ2=11.69;8.45%:30.56%,χ2=11.09;均P<0.01)。易化PCI组术后IRA血流TIMI-3级率高于直接PCI组(98.61%:88.73%,χ2=4.35,P<0.05)。②AMI后28周随访时,易化PCI组左室射血分数(LVEF)、左室峰射血率(PER)较溶栓组增高(t=2.21、2.29,均P<0.05),同时左室峰射血率时间(TPER)、PVI降低(t=2.41、2.37,均P<0.05);易化PCI组LVEF、PER较直接PCI组增高(t=2.08和2.13,均P<0.05),同时TPER、PVI降低(t=2.10、2.49,均P<0.05)。③随访28周,易化PCI组和直接PCI组MACE发生率均低于溶栓组(8.33%:54.29%,χ2=35.05;8.45%:54.29%,χ2=34.49;均P<0.01);3组间主要脏器大出血和颅内出血的发生率均差异无统计学意义。结论:经桡动脉入径易化PCI治疗可早期充分、持久地开通IRA,能在AMI早期阻抑AMI急性左室重构过程,改善左室收缩功能,其效应优于直接PCI和单纯溶栓治疗。Objective：To evaluate the effect of primary percutaneous coronary intervention（PCI）,transradial facilitated PCI and thrombolysis therapy on ventricular remodeling in the eldly with acute myocardial infarction（AMI） by equilibrium radionuclide angiography（ERNA）.Method：One hundred and forty-three primary anterior ST segment elevation AMI patients of onset10 hours were randomly divided into primary PCI group（n=71） and facilitated PCI group（n=72）,while 70 patients with matching clinical features for thrombolytic treatment group at the same period.At 1 and 28 weeks after AMI onset,the parameters of left ventricular systolic function and paradox volume index（PVI） were measured by ERNA,and major adverse cardiac events（MACE） were recorded.Result：①The patency of IRA before PCI in thrombolytic treatment group and facilitated PCI group were markedly higher than that in primary PCI group（31.43% vs 8.45%,χ2=11.69;30.56% vs 8.45%,χ2=11.09;P〈0.01,respectively）.The TIMI-3 grade rate of IRA post-PCI in facilitated PCI group was higher than that in primary PCI group（98.61% vs 88.73%,χ2=4.35;P〈0.05）.②At 28 weeks post-AMI,the parameters of LVEF and PER in the facilitated PCI group were increased（t=2.08,2.13,P〈0.05,respectively）,while TPER,PVI were decreased（t=2.10,2.49,P〈0.05,respectively） compared with those in primary PCI group.③There were no significant differences between the facilitated group and the primary PCI group in complication rates.The incidence of MACE of 28 weeks follow-up in facilitated PCI group and primary PCI group were significantly lower than that in thrombolytic treatment group（8.33% vs 54.29%,χ2=35.05;8.45% vs 54.29%,χ2=34.49,P〈0.01,respectively）.Conclusion：The transradial facilitated PCI therapy may significantly inhibit left ventricular remodeling and improve the left ventricular function by the complete,persistent repatency of IRA,which was superiority to the primary PCI and thrombolytic therapy.

关 键 词：心肌梗死 心室功能 心室重构 血管成形术 易化 

分 类 号：R542.2[医药卫生—心血管疾病]