冠状动脉内支架术治疗梗死相关动脉完全闭塞对左心室功能的影响  

Effect of early versus late coronary stent placement in patients with an infarct-related arterial occlusion on left ventricular function

作　　者：吕安康[1] 沈卫峰[1] 沈迎[1] 张继盛[1] 张大东[1] 张宪[1] 郑爱芳[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心脏科,200025

出　　处：《上海医学》2001年第10期615-617,共3页Shanghai Medical Journal

摘　　要：目的　评估延期冠状动脉内支架术治疗梗死相关动脉完全闭塞的无症状患者对左心室功能恢复的影响。方法　首次Q波前壁心肌梗死后无心绞痛症状、左前降支闭塞和梗死区心室壁无收缩的患者 6 4例 ,其中于梗死后 2～ 3周内行支架术 34例 (I组 ) ,另 30例于梗死后 3～ 6个月行支架术 (II组 )。各例于术前、术后 4～ 6个月进行超声心动图检查。结果　手术成功率I组明显高于II组 (10 0 %比 86 .7% ,P =0 .0 4)。在II组中 ,失败 4例。两组支架置入术中均无并发症发生 ,且术后残余狭窄≤ 30 %。随访期中 ,Ⅰ组左心室射血分数由5 5 %± 14%增加到 6 2 %± 13 % (P <0 .0 0 1) ;左心室收缩末期容量显著缩小 ,但舒张末期容量无明显改变。Ⅱ组的左心室收缩末期和舒张末期容量、射血分数及梗死区室壁运动均无显著改变。结论　心肌梗死后 ,梗死区残余心肌 (“冬眠心肌”)可存活 2～ 3周 ,但一般不能持续 3个月。在这一再通治疗的时间窗内 ,即使患者无症状 。Objective To evaluate the effect of early versus late revascularization of asymptomatic patients with a totally occluded infarct related artery (IRA) on left ventricular (LV) function. Methods Sixty four consecutive asymptomatic patients after a first Q wave anterior wall myocardial infarction (MI) with persistent left anterior descending artery occlusion and infarct zone akinesia were studied. Coronary stenting was performed 2～3 weeks after infarction in 34 patients (group I), and 3～6 months after the acute event in 30 patients ( group II ). Resting two dimensional echocardiographic examinations were made before the procedure and during 4～6 months of follow up. Results In group Ⅰ, the occluded left anterior descending artery could be recanalized, and full anterograde flow was restored in all patients. In group Ⅱ, stent implantation was successful in 26 patients(100% vs 86.7%, P =0.04), and was not possible in 4 patients ( guidewire failed to pass through the lesion and no vessel stump visible). No complications occurred and residual stenosis was ≤30% after stenting in both groups. In group Ⅰ, left ventricular ejection fraction increased from 55%±14% to 62%±13%( P <0.001)and a decrease in left ventricular end systolic volume, but left ventricular end diastolic volume remained unchanged. In group Ⅱ, left ventricular ejection fraction, infarct zone wall motion and left ventricular volume did not improve.Conclusion The study indicates that myocardial viability (“hibernation”) may persist for 2 to 3 weeks but not persist for 3 months after myocardial infarction. During the time, restoration of patency of infarct related artery after a Q wave myocardial infarction is beneficial even for asymptomatic patients.

关 键 词：心肌梗死 血管闭塞 左心室功能 冠状动脉内支架术 

分 类 号：R540.5[医药卫生—心血管疾病]