急性心肌梗死患者甲襞微循环障碍与左室重构及心功能变化

The Relationship between Nailfold Microcirculation and Actuemyocardial Infarction of Left Ventricular Remodeling and Cardiac Dysfunction

目的:探讨急性心肌梗死(AMI)患者甲襞微循环(NFM))障碍与左室重构(LVR)及心功能变化的关系。方法:选择72例确诊AMI病人,根据NFM程度由轻到重分为A、B、C三组,分别用心脏彩超测定其左室射血分数(LVEF)及LVR指标,如节段性心肌收缩异常、室壁瘤、节段性室壁变薄、左室舒张未内径(LVEDD)。结果:3组间NFM障碍越重,LVEDD扩大和LVEF下降越明显,差异有统计学意义(P<0.05)。NFM重度障碍的C组与B组、A组相比,LVR(如室壁变薄及形成室壁瘤等)较严重,差异有统计学意义(P<0.05)。结论:NFM障碍越重,越容易发生LVR,引起左室扩大,导致左室收缩功能降低。提示对AM1治疗,在积极开通心外膜动脉的同时,加强微循环障碍的治疗,对改善AMI预后、减轻LVR、改善心功能具有重要临床意义。

Objective:To investigate the relationship between the naklfold microcirchulation and acute myocardiac infarction(AMI)of left ventricular remodeling(LVRM)and cardial dysfunction.Method:72 inpatients with confirmed AMI were chosen as recruited subjects according to their three levels of the obstruction of the nailfold microcirculation,mild,moderate and severe,patients divided into A,B,C group respectively.LVEF and IVRM were measured by the heart color ultrasound diagnlstic appatatus,such as segmental myocardialcontraction abnormalities,aneurysm,segmental wall thinning and left rentricular diastolic diameter(LVEDD).Results:LVEDD of the patients in the three groups increased with heavier obstruction of microcirculation and LVEF level decreased significantly.The difference was statistically significant(P<0.05).The group with relatively severe obstruction of microcirculation compared to were more vulnerabie to LVRM more prone to the formation of aneurysm wall,the difference was statistically significant(P<0.05).Conclusion:The more severe dysfunction of microfuction,the more prone to LVRM,which caused left rentricular expansion,resulting in decreased left ventricular systolic function.In the treatment of AMI,when heart artery has been cleared meanwhile,the treatment of microcirculation should be strengthened,which has important clinical significance in improving the prognosis of AMI and recuding LVRM and improving heart function.