摘要
目的应用心肌呈色分级(MBG)的方法评价前壁急性心肌梗死(AM I)患者直接经皮冠状动脉介入术(PC I)后的无复流现象对心室功能的影响。方法应用MBG方法将128例首发前壁AM I患者分为无复流组和有复流组。另选择同期入院未行PC I的首次前壁AM I患者40例为未开通组。所有患者于PC I后即行左心室造影(LVG),测定心室压力、容积参数和室壁运动积分(WMS);AM I后1 w时行平衡法核素心室造影(ER-NA),测定左室收缩功能、舒张功能;AM I后6个月随访时重复行冠脉造影(CAG)、LVG和ERNA检查测定上述参数。结果(1)无复流组症状发作至球囊扩张时间较有复流组显著延长,CK-MB峰值和K illip≥2级心力衰竭发生率较有复流组明显增高。(2)AM I-PC I后6个月随访时,无复流组左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、WMS和左心室舒张末期压(LVEDP)均较有复流组明显增高;ERNA参数比较,无复流组左心室射血分数(LVEF)、高峰射血率(PER)和高峰充盈率(PFR)各参数均较有复流组明显降低,同时达到PER的时间(TPER)明显延长。结论经MBG判定的直接PC I后的无复流现象反映了梗死相关区(IRZ)的心肌仍处于失灌注状态,导致左心室功能的降低,促进心室重构,直接影响AM I患者的长期预后。
Objective To investigate the effect of no-reflow phenomenon of post-percutaneous coronary intervention （PCI） identified by myocardial blush grades （MBG） on left ventricular function in patients with acute myocardial infarction （AMI）. Methods 128 patients with first AMI of anterior wall identified by MBG were divided into no reflow group and reflow granp. 40 patients with first AMI of anterior wall without PCI were involved in no-repatency group. All patients received left ventriculography （LVG） after PCI to determine ventricular pressure, volume and wall movement seoring （WMS）o Equilibrium radionuclide angiography （ERNA） were performed 1 week after PCI to detect the parameters of left ventricular systolic and diastolic function. All above were followed-up and reinvestigated 6 month after AML Resuits 1. The time interval of onset to balloon was longer, the value of CK-MB and the incidence of Killip≥2 grade of no reflnw group were higher than those of reflow group. 2o Following-up 6 month after AMI-PCI, the values of LVESVI, LVEDVI, WMS and LVEDP in no reflow group were significant increased, while LVEF, PER and PFR of ERNA parameters were significantly decreased than those in the reflow group, accompanying the prolongation of TPER. Conclusions No reflow phenomenon identified by MBG reflects the infraeted related zone （IRZ） myoeardimn of post-AMI still has been no repeffusion status, and directly causes the reduction of global left ventrieular systolic performanee, then deteriorates the veutricular remodeling with adverse long-term outcome in patients with AMI.
出处
《中国老年学杂志》
CAS
CSCD
北大核心
2006年第2期161-164,共4页
Chinese Journal of Gerontology
