摘要
目的 探讨侧支循环在急慢性心肌缺血中的作用及在急性心肌梗死(AMI)时对心肌及左室功能的保护作用。方法 15 2例于发病12h内行急诊PTCA并植入支架治疗的AMI患者,按AMI前有无心绞痛分为慢性心肌缺血组(A组)和急性心肌缺血组(B组) ,每组再按有无冠状动脉侧支循环血管分成2亚组。在PTCA术中,判定梗死相关血管(IRA) ,并评估干预前梗死相关血管的侧支循环情况,在PTCA治疗及支架植入术后,即刻再行冠状动脉造影(CAG)以对IRA血流进行TIMI分级评价。术后第3周使用彩色多普勒二维超声心动图显像仪测定心脏左室射血分数(LVEF)及行节段室壁运动分析。结果 A组形成侧支循环例数较B组多,LVEF明显高于B组,左室室壁瘤形成的例数明显少于B组,CK -MB和CK峰值均明显比B组低,A、B组间比较均有显著性差异(P <0 .0 5 )。在A、B组中各亚组比较,有侧支循环亚组的LVEF明显高于无侧支循环亚组,左室室壁瘤形成的例数、CK -MB和CK峰值明显较无侧支循环亚组低,2亚组间比较均有显著性差异(P <0 .0 5 )。结论 急慢性心肌缺血在发生AMI时,均可形成冠状动脉侧支循环。而在慢性心肌缺血中,侧支循环形成较好,冠状动脉侧支循环形成可以最大限度的维持AMI相关区域心肌的活性。
Objective It is to study the action of collateral circulation on acute and chronic myocardial ischemia, and the protective action on cardiac muscle and left ventricle function in patients with acute myocardial infarction (AMI). Methods 152 patients with AMI undergone emergency treatment of PTCA and implanting frame within 12h from onset of AMI were divided into chronic myocardial ischemia group (group A) and acute myocardial ischemia group (group B) according to whether they had angina pectoris or not before AMI. Each group was divided into 2 subsets according to whether they had coronary collateral circulation vas or not. The infarction related arteries (IRA) were assessed with PTCA, and the condition of coronary collateral circulation in IRA was evaluated before interfered treatment. After PTCA and implanting frame, CAG were immediately done to evaluate TIMI classification in IRA. Left ventricular wall motion changes and LVEF were measured with TDE and CDFI. Results In group A, the coronary collateral circulation and LVEF were much more, ventricular aneurysm and peak of CK-Mb and CK were less than those in group B (P<0.05). LVEF were much more, ventricular aneurysm and peak of CK-Mb and CK were less in collateral circulation subset group than those in without collateral circulation subset group (P<0.05). Conclusion The coronary collateral circulation which can do best to protect left ventricle function and myocardial activity in the regional of AMI, prevent the extend of AMI area and formulation of ventricular aneursm after PTCA and implanting frame, and even lower the mortality in patients with acute and chronic myocardial ischemia, especially in chronic ones.
出处
《现代中西医结合杂志》
CAS
2005年第12期1538-1540,共3页
Modern Journal of Integrated Traditional Chinese and Western Medicine