不同程度狭窄病变冠心病患者介入治疗后心肌灌注变化及临床意义

Changes of myocardial perfusion levels after percutaneous coronary intervention in coronary artery disease patients with different stenosis degrees

目的 利用经冠状动脉超声心肌声学造影（MCE）比较单支血管不同程度狭窄病变冠心病患者经皮冠状动脉介入术（PCI）后心肌灌注的变化，并探讨其临床意义。方法 62例进行PCI治疗的住院患者根据选择性冠状动脉造影结果，按血管狭窄程度分组：A组，血管狭窄75％-95％；B组，血管狭窄〉95％；C组，急性血管闭塞。PCI前及术后15min进行经冠状动脉MCE，检测心肌灌注状况。其中，MCE有关定量参数分别为：造影剂峰值密度反映心肌血容量；峰值时间反映心肌灌注速度；曲线下面积反映心肌血流量。结果 所有患者PCI后均达到TIMIIU级血流；A组术后心肌血流量较术前增加（P〈0．05）；B组心肌血容量及血流量也较术前增加（P〈0．05）；而C组心肌血容量、血流量及灌注速度较术前增加更显著（P〈0．01）。结论 不同狭窄程度病变冠心病患者，PCI后心肌灌注均得到不同程度改善，其中，以急性闭塞病变改善最明显，该类患者为PCI治疗的最大获益者。

vention in AIM To investigate the changes of myocardial perfusion after percutaneous coronary intercoronary artery disease patients with different degree of stenosis by quantitative intracoronary myocardial contrast echocardiography （MCE）. METHODS Sixty-two patients were divided in to three groups according to the results of selective coronary angiography： group A with coronary artery stenosis 75% -95%, group B with coronary artery stenosis 〉95% and group C with coronary acute total occlusion. Myocardial reperfusion levels were evaluated before and 15 min after PCI. The quantitative parameters of MCE were analyzed, including contrast peak intensity （A）, time to peak intensity （TP） and area under the curve （AUC）, representing myocardial blood volume, reperfusion velocity and myocardial blood flow respectively. RESULTS All the target vessels achieved TIMI grade 3 flow after PCI and myocardial blood flow in group A increased after PCI（P 〈0.05）. Both myocardial blood volume and blood flow also increased in group B （P 〈 0.05 ）. Significant changes were found in all the parameters of MCE inflecting the levels of myocardial perfusion in group C （ P 〈 0. 01 ）. CONCLUSION The myocardial perfusion levels are enhanced to different degrees after successful PCI in patients with different-degree stenosis artery and the change in acute myocardial infarction patients is the most obvious.