延迟PTCA及支架术对心肌灌注及心功能的近期疗效

The Short-term Effects of Delayed Percutaneous Transluminal Coronary Angioplasty and Implanting Intracornary Stents on Myocardial Perfusion and Left Ventricular Function in Patients with Acute Myocardial Infarction

目的 :评价急性心肌梗死 (AMI)延迟经皮冠状腔内成形术 (PTCA)及支架植入术对心肌灌注及左心室功能的近期疗效。方法 :初次 AMI患者 56例分为 PTCA及支架植入组 (治疗组 ) (n=30 )和对照组 (n=2 6)。治疗组在 AMI后1 5～ 30 d行延迟 PTCA治疗。治疗组术前 1～ 3天、对照组 AMI后第 1 5～ 30天行第 1次单光子发射计算机断层及心脏超声检查 ,该检查后 1月、6月各复查 1次。结果 :治疗组术后 1月、6月梗死区域的缺血程度均较术前有明显好转(P<0 .0 1 ) ;术后差别无显著性 (P>0 .0 5)。对照组第 2、3次检查均较第 1次有明显好转 (P<0 .0 1 )。治疗组较对照组改善更为明显 (P<0 .0 1 )。 1月、6月后治疗组在射血分数、左室扩大和室壁运动异常积分同对照组相比 ,改善明显 (P<0 .0 1 )。在室壁瘤发生上 ,并无明显差别 (P>0 .0 5)。结论 :表明 AMI患者梗死后梗死区域内尚有存活心肌 ,延迟PTCA及支架植入能使梗死区内更多的心肌存活。 AMI发病后积极进行延迟 PTCA及支架植入治疗 。

Objective:To assess the short term effects of delayed percutaneous transluminal coronary angioplasty (PTCA) and implanting intracoronary stents on myocardial perfusion and left ventricular function in patients with acute myocardial infarction (AMI).Methods:56 patients with AMI were divided into delayed PTCA +stent group (treatment group) and control group.The treatment group were received delayed PTCA and coronary artery stents after AMI 15~30 days.The first examination of 99 Tc MIBI and two dimensional echocardiography was performed before PTCA +stent 1~3d ays (treatment group) and after AMI 15~30 days (control group).And followed the second examination (1 month later),the third (6 months later).Results:One month and half year after procedure (PTCA +stent),the blood flow deficit degree of myocardial infarction area in treatment group was better improved.But there were no significant difference in post procerdure (one month later and six month later ( P >0.05).So were the ventricular wall motion abnormality scores,left ventricular diatation and left ventricular ejction fraction (LVEF) ( P <0 01).And there were no significant difference in the left ventricular aneurysms ( P >0.05).Conclusion:There are residual myocardial viability in the AMI regions and PTCA+stent keeps more joepardized myocardial viable.Active therapy after AMI can significantly improve left ventricular function and myocardial perfusion.