急性心肌梗死患者心肌灌注状况对经皮冠状动脉介入术后心功能的影响

Impact of myocardial reperfusion status after percutaneous coronary intervention on improvement of left ventricular function in acute myocardial infarction patients

目的采用经冠状动脉超声心肌声学造影（MCE）评价急性心肌梗死（AMI）患者心肌灌注状况对经皮冠状动脉介入术（PCI）后心功能改善的影响,并探讨其相关临床意义。方法 18例AMI患者于PCI前及术后15 min分别经左主干或右冠状动脉注射超声声学造影剂,进行MCE实时显影,以视觉评分方式定性分析PCI前后相应心肌节段灌注状况;术后1个月经二维超声评价左心室室壁运动;利用灌注评分指数（PSI）及室壁运动评分指数（WMSI）分析PCI前后心肌灌注水平对心功能改善的影响。结果术前心肌灌注评分为0分的30个心肌节段中,20个（66.7%）术后1个月室壁运动评分为3~5分;而术前心肌灌注评分为2分的11个心肌节段中,有8个（72.7%）1个月时室壁运动评分为1~2分;统计学分析显示,PCI前心肌灌注与1个月室壁运动状况有关（P〈0.05）。术后心肌灌注评分为0分的12个心肌节段中,11个（91.7%）术后1个月室壁运动评分为3~5分;而术后心肌灌注评分为2分的22个心肌节段中,有17个（77.2%）1个月时室壁运动评分为1~2分;统计学分析显示,PCI后心肌灌注与1个月室壁运动状况有关（P〈0.01）。结合WMSI及PSI综合评价术后心肌灌注水平与左心室收缩功能的关系,发现二者存在明显相关性（P〈0.01）。结论 AMI患者心肌灌注状况对PCI后心功能改善有明显影响;经冠状动脉MCE可较准确的判断AMI患者微循环灌注范围,评估术后心功能,故可能对患者的临床预后判断有一定预测价值。

Objective To evaluate the impact of the myocardial reperfusion status after percutaneous coronary intervention（PCI） on improvement of left ventricular function in acute myocardial infarction patients by intracoronary myocardial contrast echocardiography（MCE）.Methods Eighteen acute myocardial infarction patients were selected and injected with SonoVue via left main or right coronary artery before and 15 minutes after PCI respectively.MCE images were visually valued with score on the perfusion situation of segmental myocardial regions.Left ventricular function in all patients was evaluated at 1 month after PCI.The perfusion score index（PSI） and wall motion score index（WMSI） were calculated by definite formulae.Results Among 30 myocardial segments with PSI as 0 before PCI,there were 20（66.7%） had the WMSI of 3-5 at 1 month after PCI.Among 11 myocardial segments with PSI as 2 before PCI,there were 8（72.7%） had the WMSI of 1-2 at 1 month after PCI.Statistical analysis showed that the level of myocardial reperfusion before PCI was related to the postoperative 1-month status of left ventricular segmental wall motion（P0.05）.Among 12 myocardial segments with PSI as 0 after PCI,there were 11（91.7%） had the WMSI of 3-5 at 1 month after PCI.Among 22 myocardial segments with PSI as 2 after PCI,there were 17（77.2%） had the WMSI of 1-2 at 1 month after PCI.Statistical analysis showed that the level of myocardial reperfusion after PCI was also related to the 1-month status of left ventricular segmental wall motion（P0.01）,and was obviously associated with left ventricular systolic function at 1 month after PCI（P0.01）.Conclusion The myocardial reperfusion status affects the improvement of left ventricular function after PCI in AMI patients.Intracoronary MCE can estimate the level of myocardial perfusion and left ventricular function.It might have the predictive value on clinical prognosis.