急性心肌梗死患者经皮冠状动脉介入治疗术后早期心室重构及心功能变化相关研究

Ventricular remodeling and changes in cardiac function in early postoperative stage of percutaneous coronary intervention in patients with acute myocardial infarction

目的探讨急性心肌梗死患者经皮冠状动脉介入术后早期心脏结构及心功能的变化。方法直接行经皮冠状动脉介入治疗的急性心肌梗死患者40例(AMI组),行冠状动脉造影术证实存在左冠状动脉支配区域冠心病患者40例(对照组),2组均于术前1d、AMI组于术后1周行心脏超声检查,检测心脏结构及功能。结果术前AMI组左心室质量、左心室质量指数及舒张早期峰值速度/舒张晚期峰值速度高于对照组(P<0.05);AMI组术后左心房内径、右心室内径较术前明显增大,舒张早期峰值速度、舒张晚期峰值速度、E峰下降时间较术前明显增加,左心室质量、左心室质量指数较术前明显减小(P<0.05)。结论急性心肌梗死后早期即可发生心室重构,对心室重构进行早期评价及防治是再灌注治疗的关键。

Objective To investigate changes in cardiac structure and function in the early postoperative stage of percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods Forty patients with AMI treated with PCI （AMI group） and 40 patients with left coronary artery lesions proved by coronary angiography （control group） were detected cardiac structure and function with cardiac ultrasound one day before operation and one week after operation. Results The left ventricular mass, left ventricular mass index and the ratio of ventricular diastolic peale early velocity to late velocity increased obviously in AMI group in comparison with control group （P〈0.05）. The postoperative levels of left atrial dimension, right ventricular end-diastolic dimension, ventricular diastolic peak early velocity, ventricular diastolic peak late velocity and early diastolic filling deceleration time increased significantly compared with before operation in AMI group, while left ventricular mass and left ventricular mass index significantly decreased after operation （P〈0.05）. Conclusion Ventricular remodeling occurs in the early stage of AMI. Early evaluation of ventricular remodeling and anti-remodeling therapy is the key to an ideal reperfusion therapy.