急诊PCI对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响

Effect of primary percutaneous coronary interventions on left ventricular Remodeling in patients with acute myocardial infarction accompanied with right bundle branch block

目的探讨急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死合并新发右束支传导阻滞患者左室重构的影响。方法86例新发右束支传导阻滞的AMI患者随机分为急诊PCI治疗组(45例,观察组)及静脉溶栓治疗组(41例,对照组),分别于入院后24h、1周、1个月及3月行超声心动图检查,测量左心室舒张末期容积指数、左心室收缩末期容积指数和左心室射血分数。结果急诊PCI组与静脉溶栓治疗组于术后1个月及3个月左心室容积均减小,左心室射血分数升高;术后3个月两组左心室舒张期末容积指数[(63.4±5.8)ml/m2比(67.3±6.4)ml/m2]、左心室收缩期末容积指数[(30.5±3.4)ml/m2比(34.6±4.0)ml/m2]和左心室射血分数[(0.53±0.04)%比(0.50±0.02)%],差异有统计学意义。结论急诊PCI治疗可明显抑制新发右束支传导阻滞的急性心肌梗死患者左室重构,改善左心室功能。

Objective To evaluate the effect of primary pereutaneous coronary interventions on left ventrieular remodeling in patients with acute myocardial infaretion（AMI） accompanied with the newly appeared persistent right bundle branch block （RBBB）. Methods 45 patients with acute myocardial infarction and newly appeared persistent RBBB admitted in our hospital were studied as primary PCI group. 41 patients with AMI with bundle branch block admitted in the same period served as thrombolytic therapy group. The indices of left ventricular remodeling including left ventr/cular end diastolic volume index, Left ventricular end systolic volume index, and left ventricular ejection fraction were measured by ultrasonic cardiogram on 24 h,lweek,1 month and 3 months after onset of AMI. Results At 1 month and 3 months after primary PCI, the parameters of cardiac performance were decreased significantly and left ventricular ejection fraction improved in primary PCI compared with those in thrombolytic therapy group. Left ventricular end diastolic volume index （63.4±5.8）ml/m^2 vs （67.3±6.4）ml/m^2,left ventricular end systolic volume index （30.5±3.4）ml/m2 vs （34.6±4.0）ml/m^2 and left ventricular ejection fraction（0.53±0.04）% vs （0.50±0.02）% that were notable in primary PCI group at 3 months after PCI. Conclusion Primary percutaneous coronary interventions could attenuate left ventricular remodeling and improve left ventricular function.