血运重建对急性心肌梗死患者心室重塑与心功能的影响

Effects of Revascularization on Ventricular Remodeling and Heart Function in Patients with Acute Myocardial Infarction

目的:探讨血运重建对急性心肌梗死(AMI)患者心室重塑和心功能的影响。方法:将65例AMI患者分为两组,常规强化内科保守治疗组(A组,n=20)和在此基础上的血运重建治疗组(B组,n=45),20例正常人为对照组(C组);应用超声心动图观察两组AMI后1周、3月及6月时左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)及二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)。。结果:A组和B组各时点的LVEDD、LVESD、LVEDV及LVESV均大于C组(P<0.05),LVEF和VE/VA均小于C组(P<0.05);B组6月时LVEDD、LVEDV、LVESV及3月和6月时LVESD较A组相应时点显著降低(P<0.05),而B组6月时LVEF较A组显著升高(P<0.05),A组和B组同时点间的VE/VA比较无统计学差异(P>0.05)。结论:AMI患者出现明显左室重塑和心脏收缩、舒张功能减退,血运重建可有效恢复冠状动脉前向血流,抑制AMI后中期心室重塑,并改善左室收缩功能。

Objective： To evaluate the effects of revascularization on ventricular remodeling and cardiac function in patients with acute myocardial infarction（AMI）.Methods： Sixty-five AMI patients were divided into 2 groups： conventional therapy group（group A,n=20） and revascularization group（group B,n=45）.Twenty healthy persons served as normal control（group C,n=20）.The left ventricular end-diastolic dimension and volume（LVEDD and LVEDV）,left ventricular end-systolic dimension and volume（LVESD and LVESV）,left ventricular ejection fraction（LVEF）,ratio of early and late diastolic blood flow peak velocity（VE/VA） of the 3 groups were determined by echocardiography at the 1st week,the 3rd month and the 6th month after AMI.Results： In groups A and B,LVEDD,LVEDV,LVESD and LVESV were higher,LVEF and VE/VA were lower in all time frames than those in group C（P〈0.05）.The LVEDD,LVEDV and LVESV at the 6th month after AMI,and LVESD at the 3rd and the 6th month were lower,while the LVEF on the 6th month was higher in group B than those in group A.There was no significant difference of VE/VA between group A and group B in any time frame.Conclusions： AMI leads to ventricular remodeling and cardiac dysfunction.Revascularization may inhibit ventricular remodeling and improve left ventricular systolic function in AMI patients.