急性非ST段抬高型心肌梗死患者左室舒张末压的临床相关因素研究  

Clinical correlative factors of left ventricular end-diastolic pressure in patients with acute non-STsegment elevation myocardial infarction

作　　者：周霞[1] 周少勃[1] 李国庆[1] 金元哲[1] 周东晖[1] 王勇[1] 柳兢[1] 王琦[1] 

机构地区：[1]中国医科大学附属第四医院心血管内科,沈阳110032

出　　处：《中国循证心血管医学杂志》2015年第6期780-783,786,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性非ST段抬高型心肌梗死(NSTEMI)患者中影响左室舒张末压(LVEDP)的相关因素。方法连续入选2010年1月至2014年5月于中国医科大学附属第四医院心血管内科行急诊介入治疗的NSTEMI患者84例,依据左室造影前LVEDP分为两组:A组:LVEDP≤15 mm Hg,共36例;B组:LVEDP>15 mm Hg,共48例;介入治疗前后检测N末端脑钠肽前体(NT-proBNP)、肌钙蛋白T(Tn T)、肌酸激酶同工酶MB(CKMB)。行超声心动图检查左室舒张末内径(LVEDd)、左房舒张末内径(LAEDd)、右室内径(RV)、左室射血分数(LVEF),在冠状动脉介入治疗前应用左心导管术进行LVEDP测量,左心室造影,并进行冠脉Gensini评分。结果 A、B两组患者在年龄、性别构成、Killip心功能Ⅱ级及以上、室壁运动异常比例、NT-proBNP水平、LVEF、冠脉Gensini评分、发病到开通犯罪血管时间方面存在显著性差异(P<0.05)。罪犯血管为左冠状动脉主干病变患者LVEDP显著高于其它冠脉血管病变患者(P<0.05)。发病到犯罪血管开通时间、NT-proBNP、冠脉Gensini评分、LVEF是LVEDP的危险因素。结论急性非ST段抬高型心肌梗死患者发病到犯罪血管开通时间、NT-proBNP、冠脉Gensini评分、LVEF均与LVEDP升高密切相关,对预测患者的预后有重要意义。Objective To investigate the correlative factors influencing left ventricular end-diastolic pressure（LVEDP） in patients with acute non-ST-segment elevation myocardial infarction（NSTEMI）. Methods NSTEMI patients undergone PCI（n=84） were chosen from Jan. 2010 to May 2014, and divided, according to LVEDP before left ventricular angiography, into group A（LVEDP≤15 mm Hg, n=36） and group B（LVEDP15 mm Hg, n=48）. The changes of N-terminal pro brain natriuretic peptide（NT-proBNP）, cardiac troponin T（cTnT） and creatine kinase MB（CK-MB） were observed before and after PCI, and LVEDd, LAEDd, RV and LVEF were detected by using echocardiogram. LVEDP was detected by using left heart catheterization before PCI. The patients were given examination of left ventricular angiography and coronary Gensini scoring. Results There was significant difference in age, sex, percentages of cases of Killip grade Ⅱ or higher and abnormal ventricular motion, NT-proBNP, LVEF, coronary Gensini scores and duration from disease attack to crime vessel open between group A and group B（P〈0.05）. LVEDP was significantly higher in patients with left main coronary artery as crime vessel than that in ones with other coronary artery disease（P〈0.05）. The duration from disease attack to crime vessel open, NT-proBNP, coronary Gensini scores and LVEF were risk factors for LVEDP. Conclusion The duration from disease attack to crime vessel open, NT-proBNP, coronary Gensini scores and LVEF are closely related to the increase of LVEDP in NSTEMI patients, which is significant to patient＇s prognosis.

关 键 词：非ST段抬高型心肌梗死 左室舒张末压力 GENSINI评分 

分 类 号：R541.4[医药卫生—心血管疾病]