急性心肌梗死后不同治疗手段对梗死范围回缩率的影响及预后的评估

The effect and prognosis of retraction rate with different treatment after acute myocardial infarction

目的探讨梗死范围回缩率对急性心肌梗死（AMI）预后的评估价值。方法随机入选符合标准的AMI患者122例，根据治疗手段分为4组：A组19例（急诊PCI治疗者），B组31例（延迟PCI治疗者），C组33例（溶栓再通者），D组39例（非再灌注治疗者）。应用QRS记分系统计算四组患者的心肌梗死范围回缩率，记录四组患者人院时和AMI后6个月超声心动图指标及6个月内不良心血管事件发生率，比较四组梗死范围回缩率及不同梗死部位的回缩率、超声心动图指标和心血管不良事件发生率。结果四组梗死范围回缩率比较差异有统计学意义（P〈0．05）。A、B、C三组梗死范围回缩率与D组比较差异均有统计学意义（P〈0．05）。下壁梗死范围回缩率大于前壁，但差异无统计学意义。四组患者入院时的超声心动图指标（LVESV1、LVEDVI、LVEF1）比较，差异均无统计学意义（P〉0．05）。至随访6个月时，A组LVESV2、LVEDV2、LVEF2与其他三组比较差异有统计学意义（P〈0．05）。四组病例心血管不良事件发生率比较P〈0．05，其中D组不良事件发生率明显高于A组（P〈0．05）。结论及时对罪犯血管采取干预手段，梗死范围回缩率越大，心功能指标越好，不良心血管事件发生率越低，梗死范围回缩率是预测AMI预后的简单有效手段。

Objective Discussed the prognosis value of retraction rate through different treatment,Cardiac Function and adverse cardiovascular event. Methods Randomized 122 patients suffered AMI, according to the treatment divided into four groups： Group A （19 cases, emergency PCI）, Group B （31 cases, Delayed PCI）, Group C （33 cases, intravenous thrombolytic therapy）, Group D （39 cases, non-reperfusion therapy）. Calculated these patients＇retraction rate （RR） by QRS scoring system. Recorded the admission and 6-month foUow-up indicators echocardiogram and adverse cardiovascular events. Compared four group＇s retraction rate,indicators echocardiogram, adverse cardiovascular events and the retraction rate among diffrent infarction position. Results There is obviously statistical difference of retraction rate among the four groups （P〈0.05）. Group A,B,C＇s retraction rate is significantly higher than Group D （P〈0.05）. The retraction rate of inferior wall AMI is higer than the anterior but not statistically significant. There is not statistical difference of the admission of indicators echocardiogram （LVESV1, LVEDV1, LVEF1） among the four groups （P〉0.05）. To 6-month follow-up Group A＇s LVESV2, LVEDV2, LVEF2 is significantly different than the others （P〈0.05）. Comparing the incidence of the cardiovascular adverse events among the four groups is P〈0.05, Group D＇s events is significantly higher than Group A（P〈0.05 ）. Conclusion The early you intervent the culprit artery ,the larger the retraction rate is, the better the cardiac function are and the lower the cardiovascular adverse events are. So retraction rate is a simple and effective way to forecast prognosis of AMI.