直接经皮冠状动脉介入治疗对75岁及以上急性心肌梗死患者心室重构的远期影响  

Long-term effect of direct percutaneous coronary intervention on left ventricular remodeling in patients aged 75 years and over with acute myocardial infarction

作　　者：杨兴义[1] 李淑梅[1] 屈昌文[1] 张茜[1] 

机构地区：[1]上海市第一人民医院分院干部科,200081

出　　处：《中华老年医学杂志》2015年第1期19-22,共4页Chinese Journal of Geriatrics

摘　　要：目的 研究直接经皮冠状动脉介入（PCI）治疗对年龄≥75岁的急性心肌梗死（AMI）患者心室慢性重构的影响. 方法 108例患者,PCI组在发病后12h内完成,非PCI组患者给予常规药物保守治疗,随访0.5-8.0年,随访时评估纽约心脏病学会（NYHA）心功能分级并进行超声心动图检查. 结果 106例完成随访,随访中有2例死亡,均为未行PCI治疗的女性患者,1例死于心源性猝死,另1例死于重症肺炎.与非PCI组比较,PCI组NYHA心功能分级低（t=3.17,P＜0.05）,左心室收缩末及舒张末容积较小（t值分别为3.50、3.90,均P＜0.01）,而左心室射血分数较大（t=2.00,P＜0.05）,室壁运动指数较小（t=2.96,P＜0.01）;且PCI组E/A比值较大（t=4.04,P＜0.01）,E峰减速时间较短（t=4.29,P＜0.01）,同时左心室质量指数较小（t=4.7.0,P＜0.01）;PCI组左心室长轴直径、短轴直径较短（￡值分别为2.30、5.53,均P＜0.01）,球形指数大（t=2.97,P＜0.01）. 结论 直接PCI治疗改善了高龄AMI患者慢性心室重构,有助于远期心功能的改善.Objective To investigate the long-term effect of direct percutaneous coronary intervention （PCI） on left ventricular remodeling in patients aged ≥75 years with acute myocardial infarction （AMI）.Methods 108 cases of patients with acute myocardial infarction were collected into the study.Direct PCI were completed in patients in PCI group within 12 hours of onset.Patients in non-PCI group received conventional conservative treatment with drugs.Patients were followed up for 0.5-8.0 years,and cardiac function （NYHA） and the detected ultrasonic cardiogram were evaluated during follow-up.Results The 106 patients received follow-up.Two female patients who were not treated with PCI died during follow-up,one patient died of sudden cardiac death and another patient died of severe pneumonia.Compared with non-PCI group,direct PCI group showed that cardiac function （NYHA） grade was lower（t=3.17,P＜0.05）,the end-systolic and end-diastolic volume of left ventricle were less（t=3.50、3.90,all P＜0.01）,the left ventricular ejection fraction was increased （t=2.00,P＜0.05）,the ventricular wall motion index was smaller （t=2.96,P＜0.01）.E/A ratio was higher,E wave deceleration time was shorter,and left ventricular mass index was smaller （t=4.04,4.29,4.70,respectively,all P＜0.01）,the left ventricular long and short axis diameter were decreased （t=2.30,t=5.53,P＜0.05 or 0.01）,and Spherical index was increased （t=2.97,P＜0.01）.Conclusions Direct PCI treatment improves chronic ventricular remodeling in elderly patients with AMI and contributes to long-term improvement in cardiac function.

关 键 词：心肌梗死 心室重构 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]