直接经皮冠状动脉腔内成形术与溶栓治疗对限制急性心肌梗塞梗塞面积的影响(摘要)
作者：陈步星 蒋宝琦 王伟民 徐成斌 赵红 卢明瑜 刘健 高伯山 岳明纲
单位：北京市，北京医科大学人民医院 心内科(100044)
关键词：
目的 目的：比较直接经皮冠状动脉腔内成形术(PTCA)与溶栓治疗对急性心肌梗塞患者梗塞面积和左心室功能的影响。
方法：对47例急性心肌梗塞患者，其中15例行直接经皮冠状动脉腔内成形术，32例接受静脉溶栓治疗。19例溶栓治疗临床判断再灌注，另13例临床判断未再灌注。所有病例在急性心肌梗塞后1～2周进行消心痛99mTc-MIBI心脏断层显像定量分析，测定心肌梗塞的面积。急性心肌梗塞后10～14天行超声心动图检查测定左心室射血分数。
结果：直接PTCA患者心肌梗塞面积绝对值和梗塞面积占左心室的百分数均小于溶栓再灌注组[分别为(10.46±12.53)cm2比(49.00±28.31)cm2,P<0.05;(9.13±13.61)%比(26.62±15.53)%,P<0.05],溶栓再灌注组则小于溶栓未再灌注组[分别为(49.00±8.31)cm2比(95.69±59.33)cm2,P<0.05;(26.62±15.53)%比(51.93±21.10)%,P<0.01)]。直接PTCA组左心室射血分数高于溶栓再灌注组[(64.17±8.34)%比(54.33±12.52)%,P<0.05],而溶栓再灌注组高于未再灌注组[(54.33±12.52)%比(43.15±6.95)%,P<0.01]。
, http://www.100md.com
结论：急性心肌梗塞直接PTCA与静脉溶栓治疗比较，能最大限度缩小梗塞面积，更好地保护心功能。
Limitation of Infarct Size after Primary Angioplasty Compared with Intravenous Thrombolysis in Acute Myocardial Infarction (Abstract)
Department of Cardiology, People′s Hospital, Beijing Medical University, Beijing (100044)
Chen Buxing, Jiang Baoqi, Wang Weimin, et al.
Objective: To compare the effects of primary coronary angioplasty with intravenous thrombolysis after acute myocardial infarction (AMI) on myocardial infarct size and left ventricular function.
, 百拇医药
Methods: Forty-seven patients with a first AMI underwent either primary coronary angioplasty (15 patients, group A) or intravenous thrombolysis (32 patients). According to clinical early reperfusion parameters, 32 AMI patients were divided into two groups, 19 with reperfusion group (group B) and 13 non-reperfusion group (group C). Between one and two weeks after AMI, myocardial infarct size was measured by quantitative technetium-99m sestamibi single photon emission computed tomography combined with isosorbide dinitrate infusion. Cardiac function (left ventricular ejection fraction, LVEF) was assessed by echocardiograph during 10～14 days after AMI.
, http://www.100md.com
Results: The myocardial infarct size and LVEF in group A, group B and group C were significiantly different. The absolute and relative values of infarct size of group A were smaller than those of group B [(10.46±12.53)cm2 vs. (49.00±28.31)cm2, p<0.05; (9.13±13.61)% vs. (26.62±15.53)%,p<0.05, respectively], and group B were smaller than group C [(49.00±8.31)cm2 vs. (95.69±59.33)cm2, p<0.05; (26.62±15.53)% vs. (51.93±21.10)%, p<0.01), respectively]. The LVEF of group A was higher than that of group B [(64.17±8.34)% vs. (54.33±12.52)%, p<0.05], and group B was higher than group C [(54.33±12.52)% vs. (43.15±6.95)%, p<0.01].
Conclusion: In patients with acute myocardial infarction, primary angioplasty results in a smaller infarct size and a better preserved cardiac function compared with patients receiving intravenous thrombolysis., 百拇医药
单位：北京市，北京医科大学人民医院 心内科(100044)
关键词：
目的 目的：比较直接经皮冠状动脉腔内成形术(PTCA)与溶栓治疗对急性心肌梗塞患者梗塞面积和左心室功能的影响。
方法：对47例急性心肌梗塞患者，其中15例行直接经皮冠状动脉腔内成形术，32例接受静脉溶栓治疗。19例溶栓治疗临床判断再灌注，另13例临床判断未再灌注。所有病例在急性心肌梗塞后1～2周进行消心痛99mTc-MIBI心脏断层显像定量分析，测定心肌梗塞的面积。急性心肌梗塞后10～14天行超声心动图检查测定左心室射血分数。
结果：直接PTCA患者心肌梗塞面积绝对值和梗塞面积占左心室的百分数均小于溶栓再灌注组[分别为(10.46±12.53)cm2比(49.00±28.31)cm2,P<0.05;(9.13±13.61)%比(26.62±15.53)%,P<0.05],溶栓再灌注组则小于溶栓未再灌注组[分别为(49.00±8.31)cm2比(95.69±59.33)cm2,P<0.05;(26.62±15.53)%比(51.93±21.10)%,P<0.01)]。直接PTCA组左心室射血分数高于溶栓再灌注组[(64.17±8.34)%比(54.33±12.52)%,P<0.05],而溶栓再灌注组高于未再灌注组[(54.33±12.52)%比(43.15±6.95)%,P<0.01]。
, http://www.100md.com
结论：急性心肌梗塞直接PTCA与静脉溶栓治疗比较，能最大限度缩小梗塞面积，更好地保护心功能。
Limitation of Infarct Size after Primary Angioplasty Compared with Intravenous Thrombolysis in Acute Myocardial Infarction (Abstract)
Department of Cardiology, People′s Hospital, Beijing Medical University, Beijing (100044)
Chen Buxing, Jiang Baoqi, Wang Weimin, et al.
Objective: To compare the effects of primary coronary angioplasty with intravenous thrombolysis after acute myocardial infarction (AMI) on myocardial infarct size and left ventricular function.
, 百拇医药
Methods: Forty-seven patients with a first AMI underwent either primary coronary angioplasty (15 patients, group A) or intravenous thrombolysis (32 patients). According to clinical early reperfusion parameters, 32 AMI patients were divided into two groups, 19 with reperfusion group (group B) and 13 non-reperfusion group (group C). Between one and two weeks after AMI, myocardial infarct size was measured by quantitative technetium-99m sestamibi single photon emission computed tomography combined with isosorbide dinitrate infusion. Cardiac function (left ventricular ejection fraction, LVEF) was assessed by echocardiograph during 10～14 days after AMI.
, http://www.100md.com
Results: The myocardial infarct size and LVEF in group A, group B and group C were significiantly different. The absolute and relative values of infarct size of group A were smaller than those of group B [(10.46±12.53)cm2 vs. (49.00±28.31)cm2, p<0.05; (9.13±13.61)% vs. (26.62±15.53)%,p<0.05, respectively], and group B were smaller than group C [(49.00±8.31)cm2 vs. (95.69±59.33)cm2, p<0.05; (26.62±15.53)% vs. (51.93±21.10)%, p<0.01), respectively]. The LVEF of group A was higher than that of group B [(64.17±8.34)% vs. (54.33±12.52)%, p<0.05], and group B was higher than group C [(54.33±12.52)% vs. (43.15±6.95)%, p<0.01].
Conclusion: In patients with acute myocardial infarction, primary angioplasty results in a smaller infarct size and a better preserved cardiac function compared with patients receiving intravenous thrombolysis., 百拇医药