超声心动图评价直接PCI与静脉溶栓对老年急性心肌梗死左室结构和功能的影响

Echocardiogram used to evaluate the left ventricular structure and function of aged patients with acute myocardial infarction undergoing direct percutaneous coronary intervention or throm bocystis

目的 应用超声心动图 (ECHO)评价经皮冠状动脉介入技术 (PCI)及静脉溶栓治疗老年急性心肌梗死疗效。方法 12 8例年龄大于 6 5岁的首发急性心肌梗死患者分为PCI组 (6 9例 )及溶栓组 (5 9例 ) ,均于梗死后第2周和第 4周进行ECHO检查。结果 PCI组左室舒张末期内径 (LVD)、左室舒张末期容积 (LVEDV)和左室收缩末期容积 (LVESV)前后差别无显著性意义 (P >0 0 5 ) ;射血分数 (EF)及左室短轴缩短率 (FS)前后差别有显著性意义 (P <0 0 5 ) ;室壁节段运动指数 (WMSI)降低了 8 70 %。溶栓组LVD、LVEDV、LVESV前后差别有显著性意义 (P <0 0 5 ) ;EF及FS前后差别无显著性意义 (P >0 0 5 ) ;PCI组AMI后第 2周与第 4周WMSI间差别有显著性意义。结论 PCI开通梗塞相关动脉 ,近期内改善左室重构 ,提高左室功能较静脉溶栓疗效显著。适用于溶栓禁忌证或无溶栓禁忌证的高危高龄AMI患者。ECHO是动态观察AMI后心脏结构和功能变化 ,判断预后 。

ObjectiveTo evaluate the impact of direct percutaneous coronary intervention (PCI) and thrombolytic therapy on the left ventricular structure and function of the 128 aged patients with acute myocardial infarction (AMI) by Echocardiography (ECHO).MethodsECHO was applied to observe 128 cases with first AMI,who were over 65 years old in the 2nd week and the 4th week after infarction.The 128 patients were divided into two groups,69 of them were treated with PCI,59 with thrombolytic therapy.ResultsLeft ventricular (LV) end-diastolic diameter (LVD),LV end-diastolic volume (LVEDV),LV end-systolic volume (LVESV) had no significant difference (P>0.05);ejection fraction (EF) and fraction shortening (FS) were higher (P<0.05);the decreasing percentage in wall motion score index was 8.70% (P<0.05) in PCI group.Contrary to PCI,in thrombolytic LVD,LVEDV,LVESV increased (P<0.05);EF and FS were not improved significantly (P>0.05);the percentage of WMSI was lower than PCI group (P<0.05).ConclusionLV function is improved more significantly 4 weeks after PCI than thrombilytic.Echocardiography is a useful method in evaluating LV structure and function after coronary revascular operation.