急性心肌梗塞溶栓疗效与心脏舒张功能关系

Relationship between cardiac diastolic function and the efficacy of thrombolytic therapy on acute myocardial infarction

目的 观察急性心肌梗塞（ＡＭＩ）患者静脉溶栓的临床疗效与心脏舒张功能关系。方法 选择接受静脉溶栓治疗的ＡＭＩ患者５０例，用ＨＰ２５００彩色多普勒超声心动图测定二尖瓣血流Ａ峰／Ｅ峰面积（ＶＡ／ＶＥ）、左室射血分数（ＬＶＥＦ）、短轴缩短率（ＦＳ），以及应用ＫｉｌｌｉＰ分级判定心功能。结果①３６例血管再通组与１４例未溶通组之间，在年龄、性别、ＡＭＩ部位、临床心功能、ＬＶＥＦ、ＦＳ以及高血压、糖尿病。陈旧心肌梗塞病史等方面均无显著差异（Ｐ＞ ０．０５）。②溶通组与未通组相比，ＶＡ／ＶＥ比值明显低于未通组（１．０１２９±０．３４２７比１．３３３５± ０．４０７７，Ｐ＜０．０１）；ＶＡ／ＶＥ＞１出现率少于未通组（４７．２％比８５．７％，Ｐ ＜ ０．０５）。结论 静脉溶栓治疗 ＡＭＩ使梗塞相关血管再灌注后，对左室舒张功能的保护作用可能会更大些。

Aim To observe the relation between cardiac diastolic function and the clinical efficacy of venous thrombolytic therapy on acute rnyocardial infarction (AMI). Methods In 50 patients with AMI receiving venous thrombolytic therapy the ratio of velocity area of peak A/ peak E (VA/VE) from mitral flow, left ventricular ejection fraction (LVEF), fractional shortening at minor axis (FS) were measured by Color Dopplet Flow Imeging, HP2500 and clinical cardiac functions were judged by killip grades. Results (1) There were no differencies in age, sex, AMI locations, clinical cardiac function, LVEF, FS and histories of hypertension, diabetes and old myocardial infarction both among 36 cases of reperfusion and 14 cases of non -reper- fusion (all P> 0. 05). (2)The ratio of VA/VE was lowwer in the reperfusive group than that in non - reperfusive group (1. 0129 ± 0. 3427 vs 1. 3335 ± 0. 4077, P< 0. 01); patients with VA/ VE>1 less in reperfusive group (47.2% vs 85.77%, P< 0. 05) Conclusion There might be more protective efficacy on left ventricular diastolic function after IRA reperfusion in AMI cases treated by venous thrombolytic therapy.