急性前壁心肌梗死冠脉介入术后无复流现象对心室功能的影响(1)

http://www.100md.com 2010年5月1日 李亮 李燕 吴伟力 苗青 薛玲

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     【摘要】目的：应用心肌充盈分级(MBG)的方法评价急性前壁心肌梗死患者直接经皮冠状动脉介入治疗(PCI)术后的无复流现象，并探讨无复流现象对PCI后心室功能的影响。方法：2008年5月至2009年12月首发前壁AMI并于6-12小时内行直接PCI的患者128例，应用MBG方法将患者分为无复流组(MBG 0-1级)和有复流组(MBG 2-3级)。其中无复流组36例(男22例，女14例，平均年龄66.23±13.17岁)，有复流组92例(男58例，女34例，平均年龄63.18±11.73岁)。所有患者于PCI后即行左心室造影(LVG)，测定心室压力、容积参数和室壁运动积分(WMS)；AMI后1周时行平衡法核素心室造影(ERNA)，测定左室收缩功能、舒张功能；AMI后6个月随访时重复行CAG、LVG和ERNA检查测定上述参数。结果：①无复流组症状发作至球囊扩张时间较有复流组显著延长，CK-MB峰值和Killip≥2级心力衰竭发生率较有复流组明显增高。②AMI-PCI后6个月随访时，无复流组左室收缩末期容积指数、左室舒张末期容积指数、WMS和LVEDP均较有复流组明显增高；ERNA参数比较，无复流组左室射血分数、峰射血率和峰充盈率各参数均较有复流组明显降低，同时峰射血时间明显延长。结论：经MBG判定的直接PCI后的无复流现象反映了梗死相关区(IRZ)的心肌仍处于失灌注状态，导致左室功能的降低，促进心室重构，直接影响着AMI患者的长期预后。

    【关键词】急性前壁心肌梗死； 血管成形术； 无复流现象； 心肌充盈显像； 心功能

    【中图分类号】R541.4 【文献标识码】A 【文章编号】1008-6455(2010)11-0001-02

    The effects of no reflow phenomenonon the globalleft ventricular function in patients 

    with acute anterior myocardial infarction after percutaneous coronary intervention

    Li Liang1Li Yan2Wu Weili1et al.

    【Abstract】Objective:This study was to investigate the effect of no-reflow phenomenon of post- percutaneous coronary intervention(PCI) identified by myocardial blush grades(MBG) on left ventricular function in patients with acute anterior myocardial infarction(AMI). Methods:One hundred and twenty eight patients with first AMI of anterior wall(80 male, 48 female, age 64.19±11.86 year) were involved in this study. All patients were submitted to coronary angiography (CAG), PCI and left ventriculography (LVG) about 6 to 12 hours after onset of AMI symptom and divided into two groups: no reflow group(0-1 grade) and reflow group(2-3 grade) identified by MBG. Equilibrium radionuclide angiography (ERNA) were performed in 1 week after PCI to gain the parameters of left ventricular function. All above were reinvestigated at 6th month.Results:①The time interval of onset to balloon of no reflow group was longer, the value of CK-MB and the incidence of Killip≥2 grade of no reflow group were higher than those of reflow group. ②At 6th month after AMI-PCI, the values of LVESVI, LVEDVI, WMS and LVEDP in the no reflow group were significant increasedwhile LVEF, PER and PFR of ERNA parameters were significantly decreased byas compared to those in the reflow group, and accompanied the prolongation of TPER ......

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