静脉溶栓治疗急性心肌梗死患者对其室壁瘤形成的影响

The influence of intravenous thrombolytic therapy on incidence of aneurysm in patients with acute myocardial infarction

目的：探讨静脉溶栓治疗急性心肌梗死（ＡＭＩ）患者对其室壁瘤形成的影响。方法：对４８例首次ＡＭＩ患者接受静脉溶栓治疗后３周～４周进行左室造影检查。结果：获得梗死相关冠状动脉（冠脉）再通组与未通组分别为２５例和２３例，冠脉再通组发生室壁瘤３例（发生率为１２．０％），冠脉未通组发生室壁瘤１０例（发生率为４３．５％），２组比较差异显著（Ｐ＜０．０５）。再通组左心功能改善，左室射血分数（０．６１±０．１１）明显优于未通组（０．５１±０．１２），Ｐ＜０．０５。室性心律失常发生率再通组（２８．０％）低于未通组（５６．５％）。结论：ＡＭＩ静脉溶栓治疗后梗死相关冠脉再通可显著降低室壁瘤的发生率，改善患者的心功能和预后。

Objective:To investigate the influence of intravenous thrombolytic therapy on incidence of aneurysm in patients with acute myocardial infarction (AMI).Methods:Fortyeight patients with first attack of AMI were treated by thrombolytic therapy,and routine left ventricular angiography was done in 3 to 4 weeks after thrombolysis.Results:According to the clinical criteria of reopening of the infarctionrelated arteries,reopening and nonreopening occurred in 25 cases and 23 cases,respectively.The incidences of aneurysm were 120% and 435% in reopening group (n=3) and nonreopening group (n=10) respectively,and the difference was significant (P<005).Also,in the reopening group the left ventricular function was significantly improved (left ventricular ejection fraction:061±011 vs.051±012,P<005),and the incidence of ventricular arrhythmia was lower (280% vs.565%) compared to those in nonreopening group.Conclusions:It is revealed that reopening by intravenous thrombolytic therapy can markedly reduce the incidence of aneurysm,and improve left ventricular function as well as prognosis in patients with AMI.