急性心肌梗死患者介入治疗后心肌组织再灌注不良  

Myocardial poor reperfusion status after interventional therapy in patients with acute myocardial infarction

作　　者：贾国力 韩彩萍[1] 邢程[1] 

机构地区：[1]周口市中心医院心脏病科,河南省466000

出　　处：《江苏医药》2015年第3期293-295,共3页Jiangsu Medical Journal

摘　　要：目的探讨急性心肌梗死(AMI)行急诊经皮冠状动脉介入(PCI)治疗后心肌再灌注不良及其对临床预后的影响。方法回顾性分析68例AMI急诊PCI治疗患者(36-85岁)的临床资料。以ST段回落程度与心肌梗死溶栓治疗心肌灌注分级评估心肌组织再灌注状态,并将患者分为四组:A组27例(39.7%),再灌注良好;D组10例(14.7%),再灌注不良;B组20例(29.4%)和C组11例(16.2%)的再灌注状态介于A、D组之间。分析随访期间严重心血管不良事件(SCAE)的发生风险。结果与A组比较,D组患者的左室射血分数低、梗死后心绞痛和远端栓塞发生率高、应用主动脉内气囊反搏辅助者比率增加、住院时间长、心源性病死率高(P<0.05)。以D组作为参照绘制生存曲线显示,A组随访期间SCAE的发生风险为2.7%(P<0.01),C和B组分别为43.0%(P>0.05)和24.0%(P<0.01)。结论 AMI行急诊PCI治疗后致病血管再通者中,仅有不到40%患者的心肌组织得到了良好的再灌注,近、远期预后较好;有超过10%的患者心肌组织处于较差的再灌注状态,存在极高的SCAE发生风险。Objective To explore the myocardial poor reperfusion status after percutaneous coronary intervention（PCI） in the patients with acute myocardial infarction（AMI）. Methods Data of 68 patients aged 60 to 86 years old with acute ST-elevation myocardial infarction（STEMI） undervent PCI were retrospectively analyzed. On the basis of the evaluation of myocardial reperfusion status, the patients were assigned into 4 groups of A（with good myocardial reperfusion, 27 cases）, B（with mild reduced myocardial reperfusion, 20 cases）, C（with moderate reduced myocardial reperfusion, 11 cases） and D（with serious poor myocardial reperfusion, 10 cases）. The risk for serious cardiac adverse events （SCAE） during follow-up was analyzed. Results Compared with group A, the patients in group D had less left ventricular ejection fraction,higher incidences of angina pectoris and distal embolization after AMI,increased percentage of using intraarterial balloon counter-pulsation, longer hospital stay and higher cardiac mortality. With reference to group D, the survival curve showed that the risk for SCAE was 43.0% in group C（P〈0. 05） ,24.0% in group B（P〈0. 01） and 2.7% in group A（P〈0. 01）. Conclusion In AMI patients having recanalization after PCI, the disease-related myocardium gets better reperfusion and short- and long-term prognosis in about 40% eases only and has poor myocardial reperfusion status in more than 10% cases, in whom the higher risk for SCAE exists.

关 键 词：心肌梗死 心肌再灌注 经皮冠状动脉介入 

分 类 号：R542[医药卫生—心血管疾病]