溶栓后PCI术与直接PCI术对急性心肌梗死患者近期心功能的影响  

Effects of Delayed PCI after thrombolysis and Primary PCI on heart function of patients with AMI

作　　者：邓长金[1] 彭娜[1] 成威[1] 魏国政[1] 徐晓东[1] 邵玲[1] 

机构地区：[1]湖北省荆门市第一人民医院心内科,湖北荆门448000

出　　处：《临床心血管病杂志》2014年第9期779-781,共3页Journal of Clinical Cardiology

摘　　要：目的：评价直接PCI术与溶栓后不同血流状态患者行择期PCI术对急性心肌梗死（AMI）患者心功能的影响。方法：回顾性分析54例AMI并行PCI术的患者,分为直接PCI组20例,溶栓后IRA血流TIMI 0、Ⅰ级组14例和溶栓后IRA血流TIMIⅡ、Ⅲ级组20例,通过二维超声心动图观察3组术后3d、术后30d和术后90d的左心室收缩功能的变化。结果：所有患者经治疗后,血管再通率达100%。直接PCI治疗后30d、90d的AMI患者左心室射血分数（LVEF）、左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）较之术后3d时改善明显;溶栓后血流TIMI 0、Ⅰ级的患者术后LVEF值、LVEDVI、LVESVI有所改善,但较之直接PCI组却明显降低;但溶栓后血流TIMIⅡ级和Ⅲ级的患者术后上述指标的改善与直接PCI组无明显区别。结论：AMI起病7~10d再开通血管的患者心功能明显不如急诊开通者,而不管是急诊PCI还是溶栓开通血管后再行择期PCI均可使患者心功能得到明显改善。Objective：To evaluate the effect of delayed PCI after thrombolysis with different blood flow states and primary PCI on heart function of patients with AMI. Method：According to the different conditions 54 patients with AMI underwent delayed PCI after thrombolysis 7-10 days or primary PCI. These patients were divided into three groups , of whom 20 underwent primary PCI and 14 after thrombolysis with IRA flow TIMI class 0- I and 20 after thrombolysis with IRA flow TIMI class Ⅱ- Ⅲ. The echocardiography was applied to observe the alterna- tive of left ventricular systolic function during 3 days and 30 days and 90 days. Result： Reperfusion rate in these treated patients were 100 ~/00. The improvements of LVEF and LVESVI and LVEDVI were significant after prima- ry PCI; these improvements in those patients after thrombolysis with IRA flow TIMI class 0- Ⅰ were mild and less than group of primary PCI. The earnings in those patients after thrombolysis with IRA flow TIMI class Ⅱ-Ⅲ were similar with group of primary PCI. Conclusion： It can be say that heart function of patients who underwent reperfusion after onset 7-10 days inferior to emergent reperfusion. Heart function could significantly be improved whether primary PCI or delayed PCI after thrombolysis.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 溶栓治疗 心功能 

分 类 号：R542.2[医药卫生—心血管疾病]