急性ST段抬高心肌梗死直接经皮冠状动脉介入术冠状动脉无复流患者的左室功能

Analysis of left ventricular function in ST segment elevationacute myocardial infarction for angiographic no-reflow phenomenon after primary percutaneous coronary intervention

目的 研究急诊经皮冠状动脉介入 (PCI)治疗冠状动脉 (冠脉 )无复流病人的左室功能。方法 自 1999年 1月至 2 0 0 2年 10月 ,回顾性分析北京朝阳医院心脏中心 4 97例急性ST段抬高心肌梗死 (STEMI)直接PCI患者的临床和影像资料。急诊PCI支架置入即刻 ,在无影响血流的血栓、栓塞、夹层、痉挛情况下 ,冠脉造影前向血流≤TIMI 2级为无复流 ,TIMI 3级为正常血流。冠脉无复流患者 5 8例 ,利用Excel随机函数表 ,由其余 4 39例急诊PCI冠脉前向血流恢复正常的患者中随机抽取6 0例 ,为正常血流组。结果 无复流和正常血流患者的肌酸肌酶峰值、Killip心功能分级、Q波计数、WMS有显著性差异 (P <0 0 5 )。正常血流患者术后 2周WMS改善 ,LVEF、CI、SVI增加 (P <0 0 5 )。正常血流合并心功能不全的患者术后 2周LVEF、CI、SVI增加 (P <0 0 5 ) ,LVEDV、LVESV(P <0 0 1)减少 ;而无复流合并心功能不全的患者LVEDV、LVESV增加 (P <0 0 1)。结论 无复流患者的心肌损害严重 ,梗死或濒临坏死的心肌范围广泛 ;室壁运动恢复较慢和局部心肌功能不良 ;

Objective To probe the clinical implication of left ventricular function for angiographic no reflow phenomenon after primary percutaneous coronary intervention (PCI) Methods Cilnical and angiographic data of 497 patients with ST Segment Elevation Acute Myocardial Infarction after primary PCI were retrospectively analyzed between January 1999 and October 2002 Angiographic no reflow phenomenon was defined as substantial coronary antergrade flow ≤TIMI 2 class without mechnical obstruction of embolism, thrombus, dissection and spasm in influence of normal flow after PCI, but normal flow defined as TIMI 3 class Assigned to the no flow group were 58 patients with angiographic no reflow phenomenon, and 60 patients randomized from 439 patients with coronary antergrade flow TIMI 3 class after primary PCI were to the normal flow group, using random count table of Excel Results Enzyme value, Killip class, number of Q waves on electrocardiogam and WMS differed significantly in the two groups with the angiographic no reflow phenomenon and with the normal flow ( P <0 05) WMS、LVEF、CI、SVI improved 2 weeks after the procedure in the normal flow group ( P <0 05) WMS、LVEF、CI、SVI improved , and LVEDV、LVESV decreased in the normal flow group complicated with left ventricular dysfunction 2 weeks after the procedure ( P <0 01) However, LVEDV、LVESV increased in patients with angiographic no reflow phenomenon complicated with left ventricular dysfunction 2 weeks after the procedure ( P <0 01) Conclusion The angiographic no reflow phenomenon identifies patients who have suffered from serious myocardial damage、larger area of necrotic and jeopardized myocardium , and promotes slow restoration and dysfunction of regional wall motion, and results in diastolic and systolic left ventricular dysfunction