急性心肌梗塞患者经皮冠状动脉腔内成形术前后血液动力学改变(摘要)
作者：杨锐英 陈树兰
单位：宁夏回族自治区银川市，宁夏医学院附属医院 心血管研究所(750004)
关键词：
中国循环杂志99zk25 目的：急性心肌梗塞(AMI)的发病率、致残率及致死率都很高，因此，多年来一直受到国内外学者的关注。本研究将经皮冠状动脉腔内成形术(PTCA)用于AMI患者，通过观察PTCA前后血液动力学变化，进一步探讨AMI时，施行急诊PTCA的临床意义。
方法：20例研究对象全部为AMI患者。其中男性12例，女性8例，平均年龄57.8±11.9岁。根据临床表现心电图、血清酶学及冠状动脉造影确定诊断。分别应用左右心导管技术测定AMI患者PTCA前后血液动力学指标，测定指标包括：肺毛细血管楔压(PCWP)、平均肺动脉压(MPAP)、平均主动脉压(MaoP)、左心室舒末压(LVEDP)、心输出量(CO)、心排指数(CI)、肺循环阻力(PVR)和体循环阻力(SVR)。PTCA术在AMI发病后6小时内施行，采用常规方法。所测数值以平均数±标准差表示，急诊PTCA前后血液动力学改变的比较采用t检验。
, 百拇医药
结果：研究发现：PTCA前后，AMI患者血液动力学指标有明显改变，其中PCWP、MPAP和LVEDP 3项指标在PTCA后明显下降，差异非常显著(P<0.01)。另外，MaoP、CO、CI值有所增加，PVR和SVR值有所降低，但差异无显著性(P>0.05)。
结论：本研究将急诊PTCA技术用于AMI患者，观察20例患者PTCA前后血液动力学改变，结果发现与术前相比，PTCA术后患者PCWP、MPAP、LVEDP均明显下降，这表明：急诊PTCA后，由于阻塞的冠状动脉迅速再通，缺血区域血运得到改善，在治疗AMI、恢复缺血心肌的再灌注方面，这一疗法具有重要的临床价值。本研究中，PTCA术后，CO、CI、PVR和SVR值改变不明显，与本组入选病例心肌梗塞面积较局限且无严重并发症有关。PCWP、MPAP、LVEDP较其它指标更能敏感地反映PTCA前后的心功能状况，检测这些指标，对评估AMI的病情及疗效，判定预后有参考价值。总之，AMI患者急诊PTCA术后左心功能得到明显改善，为AMI治疗提供了乐观的前景。
, 百拇医药
The Change of Hemodynamic Indices before and after Percutaneous Transluminal Coronary Angioplasty in Patients with Acute Myocardial Infarction (Abstract)
Cardiovascular Institute, Affiliated Hospital, Ningxia Medical College, Yinchuan (750004), Ningxia Hui Aotonomous Region
Yang Ruiying, Chen Shulan.
Objective: To observe the change of hemodynamic indices before and after immediate percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
, 百拇医药
Methods: Twenty patients with AMI were suudied, including 12 males and 8 females, the average age was 57.8±11.9 years old. The hemodynamic indices were measured by left and right catheterization before and after PTCA, including pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (MPAP), mean aorta pressure (MAoP), left ventricular end diastolic pressure (LVEDP), cardiac output (CO), cardiac index (CI), pulmonary vascular resistance (PVR) and systematic vascular resistance (SVR). PTCA was Carried on with in 6 hours after occurrence of AMI.
, 百拇医药
Results: The results showed that, compared with the hemodynamic indices before PTCA, the hemodynamics indices after PTCA was improved. PCWP, MPAP and LVEDP were increased significantly after PTCA (p<0.01). In addition, MAop, CO and CI were also increased, PVR and SVR were decreased, but the difference was in significant (p>0.05). The results indicated that, after immediate PTCA the obstructive coronary artery was repatency, the ischemic region was reperfused the infarcting area was reduced. Therefore, left ventricular diastolic function was improved significantly.
Conclusion: In conclusion, our study suggested that immediate PTCA after AMI is an effective procedure in the treatment of AMI., http://www.100md.com
单位：宁夏回族自治区银川市，宁夏医学院附属医院 心血管研究所(750004)
关键词：
中国循环杂志99zk25 目的：急性心肌梗塞(AMI)的发病率、致残率及致死率都很高，因此，多年来一直受到国内外学者的关注。本研究将经皮冠状动脉腔内成形术(PTCA)用于AMI患者，通过观察PTCA前后血液动力学变化，进一步探讨AMI时，施行急诊PTCA的临床意义。
方法：20例研究对象全部为AMI患者。其中男性12例，女性8例，平均年龄57.8±11.9岁。根据临床表现心电图、血清酶学及冠状动脉造影确定诊断。分别应用左右心导管技术测定AMI患者PTCA前后血液动力学指标，测定指标包括：肺毛细血管楔压(PCWP)、平均肺动脉压(MPAP)、平均主动脉压(MaoP)、左心室舒末压(LVEDP)、心输出量(CO)、心排指数(CI)、肺循环阻力(PVR)和体循环阻力(SVR)。PTCA术在AMI发病后6小时内施行，采用常规方法。所测数值以平均数±标准差表示，急诊PTCA前后血液动力学改变的比较采用t检验。
, 百拇医药
结果：研究发现：PTCA前后，AMI患者血液动力学指标有明显改变，其中PCWP、MPAP和LVEDP 3项指标在PTCA后明显下降，差异非常显著(P<0.01)。另外，MaoP、CO、CI值有所增加，PVR和SVR值有所降低，但差异无显著性(P>0.05)。
结论：本研究将急诊PTCA技术用于AMI患者，观察20例患者PTCA前后血液动力学改变，结果发现与术前相比，PTCA术后患者PCWP、MPAP、LVEDP均明显下降，这表明：急诊PTCA后，由于阻塞的冠状动脉迅速再通，缺血区域血运得到改善，在治疗AMI、恢复缺血心肌的再灌注方面，这一疗法具有重要的临床价值。本研究中，PTCA术后，CO、CI、PVR和SVR值改变不明显，与本组入选病例心肌梗塞面积较局限且无严重并发症有关。PCWP、MPAP、LVEDP较其它指标更能敏感地反映PTCA前后的心功能状况，检测这些指标，对评估AMI的病情及疗效，判定预后有参考价值。总之，AMI患者急诊PTCA术后左心功能得到明显改善，为AMI治疗提供了乐观的前景。
, 百拇医药
The Change of Hemodynamic Indices before and after Percutaneous Transluminal Coronary Angioplasty in Patients with Acute Myocardial Infarction (Abstract)
Cardiovascular Institute, Affiliated Hospital, Ningxia Medical College, Yinchuan (750004), Ningxia Hui Aotonomous Region
Yang Ruiying, Chen Shulan.
Objective: To observe the change of hemodynamic indices before and after immediate percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
, 百拇医药
Methods: Twenty patients with AMI were suudied, including 12 males and 8 females, the average age was 57.8±11.9 years old. The hemodynamic indices were measured by left and right catheterization before and after PTCA, including pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (MPAP), mean aorta pressure (MAoP), left ventricular end diastolic pressure (LVEDP), cardiac output (CO), cardiac index (CI), pulmonary vascular resistance (PVR) and systematic vascular resistance (SVR). PTCA was Carried on with in 6 hours after occurrence of AMI.
, 百拇医药
Results: The results showed that, compared with the hemodynamic indices before PTCA, the hemodynamics indices after PTCA was improved. PCWP, MPAP and LVEDP were increased significantly after PTCA (p<0.01). In addition, MAop, CO and CI were also increased, PVR and SVR were decreased, but the difference was in significant (p>0.05). The results indicated that, after immediate PTCA the obstructive coronary artery was repatency, the ischemic region was reperfused the infarcting area was reduced. Therefore, left ventricular diastolic function was improved significantly.
Conclusion: In conclusion, our study suggested that immediate PTCA after AMI is an effective procedure in the treatment of AMI., http://www.100md.com