冠心病不同类别与左心室重构及心脏功能  

Influence of Different Types of Coronary Heart Disease on Cardiac Remodeling and Function

作　　者：郭雪微[1] 马玉山[1] 施一凡[1] 郑云燕[1] 苏双善[1] 盛铁仁[1] 郭杰[1] 

机构地区：[1]甘肃省人民医院心血管病研究中心,甘肃省兰州市730000

出　　处：《中国循环杂志》2003年第2期108-110,共3页Chinese Circulation Journal

摘　　要：目的 :应用心脏超声心动图检查评价冠心病不同类别、心肌梗死 (心梗 )不同部位对左心室重构和心脏功能的影响。方法 :研究对象包括冠心病患者 2 14例 (冠心病组 ) ,非冠心病患者 86例 (对照组 ) ,均经选择性冠状动脉造影证实。冠心病患者包括稳定性心绞痛 2 8例、不稳定性心绞痛 5 3例、急性心梗 10 3例和陈旧性心梗 3 0例。急性心梗患者分为前壁、下壁、前壁 +下壁心梗。应用美国ACUSON公司生产 12 8XP/10电脑声像仪测定心脏各项指标。结果 :冠心病组与对照组相比 ,左心室舒张末内径有不同程度的增大 ,左心室质量增加、左心室舒张末和收缩末容积增加 ,左心室射血分数降低 ,均有显著性差异 (P <0 0 0 0 1～ 0 0 5 )。其中 ,陈旧性心梗以左心室质量增加为著 ,急性心梗以左心室舒张末内径增大为著。前壁和前壁 +下壁心梗对左心室重构和左心室射血分数影响更大。结论 :冠心病不同类别对左心室重构和心脏功能影响不同。心梗是造成左心室重构和心脏收缩功能减弱的主要原因。前壁和前壁 +下壁心梗对心脏功能影响更大。临床上应用超声心动图检查了解冠心病对心脏功能的影响和程度对预后的判断有重要意义。Objective: To evaluate the influence of different types of coronary heart disease (CHD) and different regions of acute myocardial infarction (AMI) on left ventricular remodeling and systolic function by echocardiography. Methods: Our study included 214 patients with CHD and 86 patients without CHD (No CHD) verified by selective coronary angiography.CHD patients were divided into stable angina pectoris (SAP, n=28), unstable angina pectoris (UAP, n=53), AMI (n=103) and old myocardial infarct (OMI, n=30) based on cTnT, cardiac enzyme and ECG.AMI patients were further divided into subgroups including acute anterior myocardial infarct (Aa, n=52), acute inferior myocardial infarct (Ai, n=37) and Aa+Ai (n=14) based on ECG.Cardiac parameters 〔end-diastolic interventricular septum thickness (IVSd), end-diastolic left ventricular internal diameter(LVd),left ventricular mass (LM), end-diastolic left ventricular volume (EDV),end-systolic left ventricular volume (ESV) and left ventricular ejection fraction (LVEF)〕 were measured by ACUSON 128XP/10 echocardiography. Results: EDV, ESV and EF in patients with AMI, OMI and UAP were significantly changed (p<0.0001～0.05).LM was mainly increased in patients with OMI and LVd was mainly increased in patients with AMI (p<0.01).EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in patients with Aa and Aa+Ai. Conclusions: Different types of CHD and different regions of AMI have different effects on the left ventricular remodeling and cardiac function.Myocardial infarction is one of the most important causes of left ventricular remodeling and cardiac dysfunction.Cardiac function is more seriously injured in anterior and/or inferior infarction. To understand the effect of CHD on cardiac function is important for prognosis.

关 键 词：冠心病 类别 左心室重构 心脏功能 超声心动图 

分 类 号：R541.4[医药卫生—心血管疾病]