ST段抬高型心肌梗死pPCI术后心肌血流灌注延迟时间临床价值

Clinical value of myocardial perfusion delaying time after pPCI in acute myocardial infarction

目的探讨ST段抬高型心肌梗死(STEMI)患者,直接经皮冠状动脉介入治疗(pPCI)术后48 h内心肌血流灌注延迟时间(MFPDT)的临床价值。方法选取并分析71例已行pPCI治疗STEMI患者的临床资料,术后48 h行左心室超声造影检查,分析MFPDT与节段心肌功能(RMF)、左心室射血分数(LVEF)的相关性;依据RMF分为轻度组和严重组,比较两组间MFPDT及LVEF差异及术后平均8.5个月房室大小、LVEF、室壁瘤发生率。正态分布计量资料行t检验,计数资料行χ^(2)检验。采用多因素Logistic回归模型分析室壁瘤形成的影响因素,P<0.05为差异有统计学意义。结果术后48 hMFPDT与RMF呈正相关(r=0.5420,P<0.0001),术后48 h MFPDT与LVEF呈弱相关,与末次随访时LVEF不相关(r分别为-0.2869、-0.1950,P分别为0.0153、0.1034)。心肌受损轻度组31例,室壁瘤4例,严重组40例,室壁瘤18例,两组术后48 h MFPDT及术后室壁瘤发生率比较差异有统计学意义(χ^(2)=19.0280、8.4100,P=0.0003、0.0037),LVEF差异无统计学意义(P>0.05),术后末次随访时两组间房室大小差异无统计学意义(P>0.05)。多因素Logistic回归分析发现,MFPDT是STEMI患者短期预后的主要影响因素(OR=3.0460,P<0.0001,95%CI:1.750~5.301)。结论STEMI患者pPCI术后48 h内MFPDT可初步预测患者心肌损伤严重程度。

Objective To analyze the clinical value of myocardial flow perfusion delay time(MFPDT)in patients with ST-segment elevation myocardial infarction(STEMI)after prime percutaneous coronary intervention(pPCI).Methods The clinical data of 71 patients with STEMI were analyzed.Within 48 h after pPCI,contrast enhanced ultrasound was performed.The correlation was analyzed between MFPDT within and the regional myocardicd fanction(RMF)48 h,also and left ventricular ejection fraction(LVEF).The patients were divided into the mild group and the severe group by the RMF,MFPDT and LVEF between the two groups were compared,as well as the atrioventricular size,LVEF,and the incidence of ventricular aneurysm during the average follow-up time of 8.5 months.Multivariate logistic regression model was used to analyze the main influencing factors on the ventricular aneurysm,t-test was used for the normal distribution measurement data,and χ^(2) test was used for counting data,P<0.05 was considered statistically significant.Results MFPDT within 48 h after pPCI was positively correlated with the RMF(r=0.5420,P<0.0001).There was a mild correlation between MFPDT and LVEF within 48h after pPCI,but not with LVEF at the last follow-up time(r=-0.2869,-0.1950,P=0.0153 and 0.1034,respectively).There were 31 cases in mild group,4 cases with ventricular aneurysm,and 40 cases in severe group,and 18 cases with ventricular aneurysm.There were significant differences in MFPDT and ventricular aneurysm between the two groups(χ^(2)=19.0280 and 8.4100,P=0.0003 and 0.0037),and there was no significant difference in LVEF(P>0.05).There were no significant differences in the size of the left chambers during the follow-up(P>0.05).Multivariate logistic regression analysis showed that MFPDT(OR=3.046,P<0.0001,95%CI:1.750~5.301)was the main short-period prognostic factor.Conclusion MFPDT after pPCI can predict the severity of myocardial injury for the patients with STEMI.