超声心动图对急性心肌梗死延迟溶栓的评价  

Evaluation of postponent thrombolysis in myocardial infarction with echocardiography

作　　者：王凤昆[1] 黄占东[1] 李景荣[1] 

机构地区：[1]北京市房山区第一医院内科,102400

出　　处：《中华超声影像学杂志》2000年第9期528-530,共3页Chinese Journal of Ultrasonography

摘　　要：目的　通过对急性心肌梗死 (AMI)延迟溶栓患者左心结构和功能的动态观察 ,评价延迟溶栓对AMI预后的影响。方法　对发病 6～ 12h的AMI 97例患者 ,分为静脉尿激酶溶栓组 39例 ,非溶栓组 5 8例。对6个月内存活的溶栓组 33例及非溶栓组 41例患者 ,于心梗后第 1个月及第 6个月分别进行超声心动图检查 ,测定左室舒张末期和收缩末期容积指数 (LVEDVI ,LVESVI)及射血分数 (EF)。结果　溶栓组血管再通率为38.5 %。溶栓组和非溶栓组死亡率分别为 15 .4% ,2 9.3 % (P >0 .0 5 )。已存活的患者左室重构的发生率 ,溶栓组 8/ 33 ,非溶栓组为 2 1/ 4 1(P <0 .0 5 ) ;血管再通组为 1/ 15 ,未通组为 7/ 18(P <0 .0 5 )。左室重构累及前壁的发生率为 2 2 / 2 9。心梗后第 1个月及第 6个月各组自身比较 ,溶栓组LVEDVI升高 (P <0 .0 5 ) ,LVESVI及EF无明显改变 (P >0 .0 5 ) ;未溶栓组及溶栓组血管未通组LVEDVI、LVESVI明显增大 (P <0 .0 1) ,EF明显下降(P <0 .0 5 ,0 .0 1) ;溶栓血管再通组各组参数均无明显改变 (P >0 .0 5 )。心梗后 6个月内未溶栓组与溶栓组比较 ,LVEDVI及LVESVI均增大 (P <0 .0 5 ) ,EF均下降 (P <0 .0 5 ) ;溶栓未通组与溶栓再通组比较LVEDVI及LVESVI均增大 (P <0 .0 5 ) ,EF无明显改变 (P >0 .0 5 )。Objective The changes of left ventricular structure and function were observed in patients acquired postponent thrombolytic therapy after acute myocardial infarction (AMI) to evaluate the effect of postponent thrombolysis on the prognosis of AMI.Methods Ninety seven patients who had just developed AMI for 6 to 12 hours were divided into intravenous UK thrombolytic group (39 cases) and nonthrombolytic group (58 cases) . Among them, 74 cases were survived for more than 6 monthes,including 33 cases in thrombolytic group and 41 cases in nonthrombolytic group. All patients were examined with echocardiography at the lst month and the 6th month after infarction.Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and ejection fraction (EF) were measured.Results The reperfusion rate of artery was 38.5% in thrombolytic group.The death rates in thrombolytic group were 15.4% and 29.3% in nonthrombolytic group (P> 0.05 ). The incidences of the left ventricular remodelling were 8/33 in thrombolytic group and 21/41 in nonthrombolytic group (P< 0.05 ), and 1/15 in arery reperfusion group and 7/18 in unreperfusion group (P< 0.05 ). The pecentage of left ventricular remodeling implicated inferior wall infarction was 22/29. An intergroup comparision was carried out to analyse the results obtained at lst month and the 6th month.In thrombolytic group,LVEDVI was increased (P< 0.05 ). LVESVI and EF had no significant changes (P> 0.05 ).LVEDVI and LVESVI were significantly higher (P< 0.01 ) and EF was lower (P< 0.01 ,P< 0.05 ) in nonthromblytic group and in unreperfusion group,and the index in artery reperfusion group had no significant changes (P> 0.05 ). Comparing the nonthrombolytic group with the thrombolitic group after AMI within 6 monthes, LVEDVI and LVESVI were higher (P< 0.05 ), EF was lower (P< 0.05 ); LVEDVI and LVESVI were higher in unreperfusion group than in reperfusion

关 键 词：超声心动描记术 心肌梗塞 血栓溶解疗法 尿激酶 

分 类 号：R542.22[医药卫生—心血管疾病]