不同介入治疗方案选择对急性心肌梗死患者心功能及心肌组织灌注的影响

Effects of different percutaneous coronary intervention on ventricular function and myocardial tissue reperfusion in acute myocardial infarction

目的对接受急诊、易化、延迟介入治疗(PCI)的急诊心肌梗死(AMI)患者心功能及心肌组织血液灌注进行评价。探讨AMI患者行PCI最佳时机和方法。方法69例AMI患者分急诊PCI(A)、易化PCI(B)、延迟PCI(C)三组。术后7d、30d行超声心动图及99 mTc-甲氧基异丁基异晴(MIBI)心肌灌注断层显像(SPECT)评价近期心功能及心肌组织灌注,观察1年期间心血管事件的发生情况。结果(1)三组患者扩张后即刻造影结果管腔残余狭窄率<10%,手术成功率100%。(2)超声心动图30d时A、B两组左心室收缩、舒张末容积指数(LVESVI、LVEDVI)、左心室射血分数(LVEF)均优于C组(。3)SPECT显像放射性缺损面积(MIA),A、B两组低于C组,A、B两组心肌组织血流灌注均优于C组。结论(1)直接PCI、易化PCI可显著提高AMI患者的近期心肌组织血流灌注,缩小心肌梗死面积,保护心功能;(2)延迟PCI宜早期进行。

objactive To evaluate the effects of different Percutaneous coronary intervention （PCI） on ventricular function and myocardial tissue reperfusion in AMI. Methods Sixty nine patients with first AMI were divided into three groups according to their choices： primary PCI, facilitated PCI and delay PCI. 7 days and one month after PCI,^99mTc-MIBI SPECT and ultrasound were performed. All patients were followed up for 12 months. Results （ 1 ） patients with remain stenosis 〈 10% after agiography. （2） Ventricular function was significantly increased more in group A and B than in group C（ P 〈 0.05 ）. （ 3 ） Myocardial infarction area （MIA） was lower in group A and B than in group C （ P 〈 0.05 ）. Conclusion （ 1 ） Primary PCI and facilitated PCI have significantly effects, including increased myocardial tissue reperfusion and limiting infarct area, protecting ventri-cular function. （2）Delay PCI should be done as early as impossible if condition was permitted.