冠心病患者左室造影的安全性研究

Safety of Left Ventriculography in Coronary Heart Disease Patients

目的:初步探讨左室造影对冠心病患者心功能的影响。方法:对113例行冠状动脉造影及左室造影患者全程进行血流动力学监测,并分别记录左室造影前、后的左室舒张末压(left ventricular end d iastolic pressure,LVEDP)。根据冠状动脉造影结果及临床表现分为冠状动脉造影正常组、不稳定型心绞痛组和急性心肌梗死组,并将急性心肌梗死组分为室壁瘤组和无室壁瘤组;并根据患者左室造影前LVEDP将全部患者分为LVEDP>20 mmHg组及LVEDP<20 mmHg组。结果:各组左室造影后的LVEDP与造影前比较均有增高趋势,但差异无显著统计学意义(P>0.05);不稳定型心绞痛组与冠状动脉造影正常组造影后LVEDP比较差异无显著统计学意义(P>0.05);而急性心肌梗死组左室造影后LVEDP与冠状动脉造影正常组和不稳定型心绞痛组比较差异具有非常显著统计学意义(P<0.001);室壁瘤组左室造影前后LVEDP比较差异有显著统计学意义(P<0.05);无室壁瘤组左室造影前后LVEDP比较差异无显著统计学意义(P>0.05);造影前LVEDP>20 mmHg组左室造影后LVEDP与LVEDP<20 mmHg组比较差异具有非常显著统计学意义(P<0.001)。结论:对于进行介入检查及治疗的非急性心肌梗死患者行左室造影是安全的,而对于急性心肌梗死患者尤其是存在室壁瘤高危因素的患者,应根据造影前LVEDP的数值选择左室造影的适应证。

Objective：The aim of this study was to investigate the safety of left ventriculography （LVG） performed in patients suffering from coronary heart disease （CHD）. Methods：113 CHD patients were submitted to coronary angiography （CAG） and left ventriculography （LVG） and were divided into three groups：normal CAG group,unstable angina pectoris （UAP） group and acute myocardial infarction （AMI） group. Besides,the AMI group was divided into left ventricular aneurysm （LVA） subsection and no LVA subsection according to the LVA formation seen in LVG. Left ventricular end diastolic pressure （LVEDP） was recorded before and after LVG. Furthermore,all patients were divided into another two groups according to the LVEDP：LVEDP 〉 20 mmHg and LVEDP 〈 20 mmHg before LVG. Results： LVEDP had a rising trend in all the groups, but had no statistical significance （P 〉 0. 05 ）. Besides, the increase of LVEDP showed no difference between UAP group and normal CAG group（P 〉 0. 05） ,but had noted increase in AMI group than in UAP group and normal CAG group （P 〈 0. 001 ）, It was also found that LVEDP after LVG was higher than that before LVG in patients with LVA （P 〈 0.05 ）, The difference between LVEDP before and after LVG was not significant in patients without VA （P 〉 0. 05）. The increase of LVEDP after LVG was noted higher in patients with LVEDP 〉 20 mmHg before LVG than that in patients with LVEDP 〈 20 mmHg before LVG （P 〈 0. 001 ）, Conclusion：LVG is safe in patients without AMI,but indication of LVG should be selected according to the index of LVEDP before LVG in AMI patients,especially patients with high possibility of LVA formation.