川芎嗪对急性心肌梗死血运重建后“心肌无复流”患者心肌组织灌注的影响

The Effect of Ligustrazine on Myocardium Microcirculation Perfusion in Patients with Acute Myocardial Infarction after Emergency Percutaneous Coronary Intervention

目的 观察川芎嗪对急性心肌梗死（AMI）患者梗死相关血管（mA）再通后心肌无复流（No．reflow，NR）现象的疗效。方法 首次急性sr段抬高心肌梗死（STEMI）患者，急诊经皮经腔冠状动脉介入（PCI）后，经单光子发射型计算机断层显像（SPECT）诊断为心肌NR者，随机分为治疗组（40例）和对照组（42例）。对照组接受常规治疗，治疗组在常规治疗基础上静脉给予川芎嗪注射液。分别于24h内（4—24h）及15d后（15—28d）复查SPECT，观察左室心肌灌注缺损积分（myocardium peffusion defect score，MPDS），左室射血分数（LVEF）、左室舒张末期容积（LVEDV）和左室收缩末期容积（LVESV）。结果 24h内及15d后，治疗组的MPDS均较PCI后即刻减低，其减低幅度均显著大于对照组（均P〈0．05）；两组的LVESV和LVEDV均呈增加趋势，但治疗组LVESV和LVEDV的增加幅度显著低于对照组（均P〈0．05）；15d后治疗组SPECT心肌NR的发生率显著低于对照组。结论 川芎嗪可显著改善心肌组织灌注，减轻心肌NR现象，从而缩小心肌坏死范围。抑制心室重构。

Objective To evaluate the effect of ligustrazine on myocardium microcirculation perfusion in patients with first acute myocardial infarction （AMI） after emergency percutaneous coronary intervention （PCI）. Methods Eighty-two patients with first AMI were randomly assigned to the Ligustrazine group（n =40, Ligustrazine administered intravenously, plus routine therapy） or control group（ n = 42, routine therapy）. All patients＇ left ventricular^99mTc-MIBI myocardial perfusion imagings at risky region were measured by means of Single-photon emission computed tomography（SPECT） and assessed by employing the 9-segment analysis with a 4-point defect score at once after successful PCI, in 24 hours and after 15 days respectively. Left ventricular ejection fraction（LVEF）, left ventricular end-diastolic volume（LVEDV） and left ventricular end-systolic volume（LVESV） were also measured simultaneously. Results Both groups showed a trend of decrease in the to- tal peffusion defect score over half a month, while the Ligustrazine group had a larger extent of chang than the control group either in 24 hours or after 15 days（ both P 〈0.05）, respectively. The LVESV and LVEDV tend to increase after PCI in both groups, while the extent of increase in LVESV and LVEDV was less significant in Ligustrazine group than that in control group both in 24 hours and 15 days later（ both P 〈 0.05）. Conclusion Intravenous administration of Ligustrazine after PCI can significantly improve myocardial microvascular perfusion, attenuate no-reflow phenomenon and left ventricular remodeling.