经皮冠状动脉介入序贯治疗对急性心肌梗死左心室功能的影响及相关因素分析

The effects of sequel recanalization percutaneous coronery intervention（PCI） therapy on cardiac function of the patients with acute myocardial infarction

目的探讨经皮冠状动脉介人（PCI）序贯治疗对急性ST段抬高型急性心肌梗死（STEMI）患者左心室功能的影响及相关因素。方法对人选的116例STEMI患者按数字表法随机分为序贯PCI组58例和58例，传统PCI组按PCI常规进行，序贯PCI组在传统PCI术前尽量吸量冠状动脉内血栓，然后再按PCI常规进行。比较两组患者在PCI治疗即刻和之后2周时左心室的收缩和舒张功能，并采用Logstic回归分析方法，探讨影响PCI临床效果的相关因素。结果序贯PCI组与传统PCI组比较，局部最大收缩末容积（RESVmax）、局部最小收缩末容积（RESVmin）、局部最大射血分数（REFmax）、局部最大舒张末期容积（RED-Vmax）、E／A比值等差异均有统计学意义（均尸〈0．05）；以序贯PCI为变量，对REFmax恢复到50％的影响进行两项Logstic回归分析，序贯PCI治疗方法的OR值为3．47，95％CI为1．39～9．75，P=0．04；影响心肌功能恢复的其它因素还有：发病到血流开始再通的时间（OR=4．59，P=0．01）、梗死面积导联数（OR=4．22，P=0．01）、人院时心功能Killip级别（OR=3．99，P=0．02）和年龄（OR=2．75，P=0．04）等。结论PCI序贯治疗可促使心功能的恢复，临床效果优于传统PCI治疗方法。

Objective To explore effects of sequel recanalization PCI therapy （primary coronary intervention, PCI） on cardiac function for the patients with acute ST segment elevation myocardial infarction（ STEMI）, and related factors. Methods 116 patients with STEMI enrolled were divided randomly into two groups：sequel recanalization PCI group（58 cases） and conventional PCI group（58 cases） ,and the patients of sequel recanalization PCI group were fully absorbed for thrombus before conventional PCI, then compared estoration of their cardiac function of the patients of two groups at once and 2 weeks after PCI procedure,respectively. Meantime to study the effect related-factors for cardiac function by Logistic regression analysis. Results There were significant differences between two groups in RESVmax（ P = 0. 03） ,RESVmin（ P = 0. 00） ,REFmax（ P = 0. 00） ,REDVmax （ P = 0. 01 ） and the ratio of E/A （ P = 0. 02） （all P 〈 0. 05 ） ;it showed that the restoration of cardiac function of sequel recanalization PCI group was faster than that of conventional PCI group. If sequel recanalization PCI served as a variable for predicting REFmax being 50%, the results of logistic regression showed that OR （odds ratio） value was 3.47,95% CI （confidence interval） 1.39-9. 75,P = 0. 04. Among other variables, as was time-to-recanalization （ OR = 4. 59, P = 0. 01 ） ;infarct size （ OR = 4. 59 ,P =0. 01） ; Kiliip grades （ OR = 3. 99 ,P =0. 02 ） and age （ OR = 2. 7 5 ,P =0. 04 ）. Condusion The sequel re- canalization PCI could be better than conventional PCI for the patients with STEMI in restoration of heart function ,but there should be some other effective factors.