溶栓后早期经皮冠状动脉介入对急性ST段抬高型心肌梗死患者心肌灌注及左心功能的影响  

Impact of early percutaneous coronary intervention after thrombolysis on myocardial perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction

作　　者：苗雅敬[1] 王晓旭 汪雁博[2] 韩高洁 仝巧立 张旭倩 吴敬兰 谷新顺[2] 尹洪宁[1] Miao Yajing;Wang Xiaoxu;Wang Yanbo;Han Gaojie;Tong Qiaoli;Zhang Xuqian;Wu Jinglan;Gu Xinshun;Yin Hongning(Department of Echocardiography,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏超声科,石家庄050000 [2]河北医科大学第二医院心血管内科,石家庄050000

出　　处：《中华超声影像学杂志》2024年第2期98-105,共8页Chinese Journal of Ultrasonography

基　　金：河北省重点研发计划项目(20377762D)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者溶栓后早期经皮冠状动脉介入(PCI)对心肌灌注及左心功能的影响。方法前瞻性收集2020年1月至2022年12月于河北医科大学第二医院就诊的STEMI患者108例, 分为溶栓后早期PCI组(65例)和直接PCI(pPCI)组(43例)。比较两组患者一般临床资料、PCI术后1 d及出院前常规超声心动图参数, 应用心肌声学造影(MCE)评估PCI术后1 d及出院前心肌灌注情况。结果溶栓后早期PCI组及pPCI组一般临床资料差异无统计学意义(均P>0.05)。溶栓后早期PCI组及pPCI组患者出院前与PCI术后1 d相比左心室射血分数(LVEF)升高, 差异有统计学意义(均P<0.05)。溶栓后早期PCI组与pPCI组相比出院前及PCI术后1 d LVEF差值变化差异有统计学意义(P<0.05)。与PCI术后1 d相比溶栓后早期PCI组及pPCI组出院前左心室整体纵向应变(LVGLS)升高(均P<0.05)。溶栓后早期PCI组与pPCI组相比出院前与PCI后1 d LVGLS差值变化差异有统计学意义(P<0.05)。溶栓后早期PCI组与pPCI组左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心房容积(LAV)、二尖瓣口舒张早期血流速度与舒张晚期血流速度比值(E/A)、二尖瓣环舒张早期运动速度的平均值(Em)及E/Em在PCI术后1 d及出院前差异无统计学意义(均P>0.05)。MCE显示, 与PCI术后1 d相比, 溶栓后早期PCI组与pPCI组在出院前MCE评分指数明显减低(均P<0.001)。与PCI后1 d相比, 溶栓后早期PCI组在出院前心肌灌注正常(nMVP)比例升高, 心肌灌注延迟(dMVP)及心肌微循环障碍(MVO)比例降低(均P<0.05)。与PCI后1 d相比, pPCI组出院前nMVP比例升高, dMVP比例降低(均P<0.05), MVO比例减少但差异无统计学意义(P>0.05)。结论急性STEMI患者采用溶栓后早期PCI和直接PCI均可以改善左心室收缩功能及心肌灌注, 溶栓后早期PCI在改善患者的左心室收缩功能及心肌灌注方面可能更具优势。Objective To investigate the effects of early percutaneous coronary intervention(PCI)on myocardial perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction(STEMI)after thrombolysis.Methods A total of 108 patients with STEMI treated in the Second Hospital of Hebei Medical University from January 2020 to December 2022 were divided into early PCI following thrombolysis group(n=65)and primary PCI(pPCI)group(n=43).The general clinical data,and the parameters of routine echocardiography at 1 day after PCI and before discharge were compared between the two groups.Myocardial contrast echocardiography(MCE)was used to evaluate myocardial perfusion at 1 day after PCI and before discharge.Results There were no significant differences in general clinical data between the early PCI following thrombolysis group and the pPCI group(all P>0.05).The left ventricular ejection fraction(LVEF)in the early PCI following thrombolysis group and pPCI group before discharge was significantly higher than that on the 1st day after PCI(both P<0.05).The difference of LVEF was significant between the early PCI following thrombolysis group and the pPCI group before discharge and 1 day after PCI(P<0.05).Compared with 1 day after PCI,the global longitudinal strain(LVGLS)of left ventricle increased in early PCI following thrombolysis group and pPCI group before discharge(both P<0.05).The difference of LVGLS between early PCI following thrombolysis group and pPCI group before discharge and 1 day after discharge was statistically significant(P<0.05).There were no significant differences in left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),left atrial volume(LAV),ratio of mitral early diastolic velocity to late diastolic velocity(E/A),mean early diastolic velocity of mitral annulus(Em)and E/Em 1 day after PCI and before discharge between early PCI following thrombolysis group and pPCI group(all P>0.05).MCE showed that the MCE score index of early PCI following th

关 键 词：超声心动描记术 急性ST段抬高型心肌梗死 溶栓后早期经皮冠状动脉介入 心肌灌注 心室功能 左 心肌声学造影 

分 类 号：R542.22[医药卫生—心血管疾病]