心肌存活及灌注对急性心肌梗死冠状动脉介入治疗术后患者心功能的影响

Influence of Myocardial Viability and Regional Perfusion on Cardiac Function of Patients with Myocardial Infarction after Percutaneous Coronary Intervention Therapy

目的探讨急性心肌梗死冠状动脉介入治疗(PCI)术后患者梗死区心肌存活性对左室重构及功能的影响。方法 2006年2月-2010年12月208例急性心肌梗死急诊PCI术后的患者接受静息状态下18氟-脱氧葡萄正电子断层显像进行心肌代谢显像检查,根据基线梗死区心肌有无存活分为两组,同时进行超声心动图检查,评价左室壁运动、左室射血分数,左室舒张末内径、左房内径及舒张期二尖瓣血流速度峰值的比值。血运重建术后12个月随访超声心动图,观察梗死区心肌存活状态对于左室重构以及心功能的影响。结果 PCI术后12个月,有存活心肌组左室射血分数(46.7±6.98)%高于无存活心肌组(45.1±7.12)%,两组差异有统计学意义(P<0.01),有存活心肌组左室舒张末期内径(53.17±3.89)mm小于无存活心肌组(55.46±4.75)mm,两组差异有统计学意义(P<0.05)。左房内径及舒张期二尖瓣血流速度峰值的比值两组随访时均无明显变化。结论急性心肌梗死行PCI治疗后的患者,在有存活心肌的情况下,心功能改善明显;而梗死区无心肌存活的患者,12个月后,心功能减低,左室重构更加明显。

Objective To discuss the influence of myocardial viability and regional perfusion of infarcted area on left ventricular remodeling and cardiac function of patients with myocardial infarction（AMI） after percutaneous coronary intervention（PCI） therapy.Methods From February 2006 to December 2010,208 AMI patients underwent 18F-fluorodeoxyglucose positron tomography imaging after PCI therapy.All of them were divided into two groups according to the myocardium viability and the baseline severity of perfusion in the infarcted area.Their cardiac functions were evaluated by echocardiography,including left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVEDD）,left atrial diameter and diastolic mitral flow peak velocity.Twelve months after remodeling,echocardiography was performed again to evaluate the influence of myocardial viability on cardiac function in the patients.Results LVEF in patients with viable myocardium at month 12 after PCI therapy was significantly higher than that in the nonviable group： （46.7 ± 6.98）% and（45.1 ± 7.12）%,P0.01.LVEDD in the nonviable group was larger than that of the viable group：（53.17 ± 3.89） mm and（55.46 ± 4.75） mm,P0.05.There was no significant difference in the other two indicators.Conclusion Cardiac function of patients with viable myocardium after PCI therapy due to AMI can be improved significantly.However,patients without viable myocardium have worse cardiac function and left ventricular remodeling after PCI.