急诊PCI与择期PCI对急性心肌梗死病人左心室功能的影响

Effect of emergency PCI and selective PCI on left ventricular function in AMI patients

目的:探讨急诊经皮冠状动脉介入治疗(PCI)与择期PCI对急性心肌梗死(AMI)病人左心室功能和预后的影响。方法:选取首次发作AMI且发病24 h内未行静脉溶栓病人43例,其中行急诊PCI病人29例(急诊组),择期PCI病人14例(择期组)。分别于PCI术前和术后1、3个月,行经胸超声心动图检查,测量2组病人左心室舒张末期前后径(LVEDD)、左心室收缩末期前后径(LVESD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)及左心室射血分数(LVEF),分析各指标前后变化。结果:2组病人PCI手术成功率均为100%。与术前比较,术后1、3个月急诊组的LVEDD、LVESD、LVEDV、LVESV指标均下降(P<0.05~P<0.01),LVEF明显升高(P<0.01);择期组LVEDD、LVEDV、LVESV均下降(P<0.05~P<0.01),LVESD变化差异无统计学意义(P>0.05),LVEF明显升高(P<0.01)。2组病人术前LVEDD、LVESD、LVEDV、LVESV差异均无统计学意义(P>0.05)。急诊组病人术后1、3个月的LVEDD、LVESD、LVEDV、LVESV均低于择期组(P<0.05)。结论:急诊PCI可改善AMI病人左心室重构,抑制左室收缩功能进一步降低,对AMI有显著疗效。

Objective： To explore the effects of emergency percutaneous coronary intervention（PCI） and selective PCI on left ventricular function and prognosis of patients with acute myocardial infarction（AMI）.Methods： The first AMI 43 patients treated without vein thrombolysis were selected,29 patients were treated with emergency PCI（emergency group）,and 14 cases were treated with selective PCI（selective group）.All patients were examined using transthoracic echocardiography（TTE） before PCI,and after 1 and 3 months of PCI,and the levels of left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD）,left ventricular end diastolic volume（LVEDV）,left ventricular end systolic volume（LVESV） and left ventricular ejection fraction（LVEF） were measured in wo groups.Results： The success rates of operation in two groups were 100%.The stent was implanted into the stenosis location of coronary artery in patients treated with PCI,and the success rate of stent implanting was 100%.Compared before operation,the levels of LVEDD,LVESD,LVEDV and LVESV decreased,and the level of LVEF significantly increased in emergency group after 1 and 3 months of operation（ P 〈0.05 to P 〈0.01）.Compared before operation,the levels of LVEDD,LVEDV and LVESV decreased（ P 〈0.05 to P 〈0.01）,the level change of LVESD was not obvious（ P 〉0.05）,and the level of LVEF significantly increased in selective group after 1 and 3 months of operation（ P 〈0.01）.The differences of the levels of LVEDD,LVESD,LVEDV and LVESV between two groups before operation were not statistically significant（ P 〉0.05）,and the levels of LVEDD,LVESD,LVEDV and LVESV in emergency group were lower than those in selective group after operation（ P 〈0.05）.Conclusions： Emergency PCI can improve the reconstruction of left ventricular,and inhibit the left ventricular systolic function in AMI patients.The treatment effect of emergency PCI on AMI is significant.