摘要
目的探讨不同时间段行经皮冠状动脉介入治疗（PCI）对急性心肌梗死（AMI）后左心室室壁瘤（LVA）形成的逆转效应及其对心功能的影响。方法选择2001年1月至2004年7月我院收治的首次前壁AMI患者，经导管法左心室造影确定合并室壁瘤者共326例，根据AMI发病后行PCI的时间分为：发病≤3h组、4～6h组、7～12h组和1周组（发病时间≥13h且小于1周），4组患者于PCI后即行导管法左心室造影，测定心室容积、压力参数和室壁运动积分；PCI术后1周时行平衡法核素心室造影，测定反常室壁容积指数；6个月时重复上述检查，并随访3年，记录主要心脏事件（MACE）的发生率。结果PCI术后6个月随访，发病≤3h组、4～6h组、7～12h组、1周组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室室壁运动积分、左心室舒张末期压力均较行PCI时降低（均P％0．05），而左心室射血分数较前增高（P％0．05），其中发病≤3h组变化最为显著。PCI术后6个月，发病≤3h组反常室壁容积指数明显低于4～6h组、7～12h组、1周组，分别为：（12．1±2．1）％与（15．4±2．4）％、（16．5±2．5）％、（20．4±3．7）％，均P〈0．05。住院期间及术后3年随访，≤3h组、4～6h组、7～12h组3组MACE发病率低于1周组，3年随访时病死率均低于1周组（分别为2．8％、3．0％、3．1％与17．9％，均P〈0．05）。结论对AMI患者越早期开通梗死相关动脉，越能有效地抑制并逆转LVA的形成，提高左心室功能，改善患者的预后。
Objective To evaluate the effect on the reversal of left ventricular aneurysm （LVA） and on heart function of percutaneous coronary intervention （PCI） therapy at different time of acute myocardial infarction （AMI）. Methods A total of 326 patients with primary anterior AMI- accompanied LVA diagnosed by left ventriculography （LVG） from January 2001 to July 2004 were enrolled in this study. They were randomized into 4 groups according to the time of accepting PCI： ≤ 3 h group, 4-6 h group, 7-12 h group and one week group. At the baseline and 6 months after AMI, the parameters of left ventricular diastolic volume index （LVEDVI）, left ventricular systolic volume index （LVESVI）, left ventricular ejection fraction （LVEF）, left ventricular wall motion score （LVWMS） and left ventricular end diastolic pressure （LVEDP） were measured by LVG. The paradox volume index （PVI） was measured by equilibrium radionuelide at one week and 6 months after AML At 3 year following up to, the major adverse cardiac events （MACE） were recorded. Results At 6 months after PCI, the I.VESVI, LVEDVI, WMS and LVEDP were all decreased while LVEF was increased in the four groups as compared with pre PCI （P〈0.05, respectively）. Those parameters changed most obviougly in ≤3 h group. At the 6th month after PCI, the PVI was lower in 43 h group （12.1±2. 1）% than in 4-6 h, 7-12 h and one week group （（15. 4±2. 4）%, （16.5±2. 5）% and （20. 4±3.7）%, all P〈0.05]. Within the 3 years follow-up, the MACE was significantly lower in 3 h, 4-6 h and 7-12 h groups than in one week group, and the mortality was lower too [（2.8%, 3.0% and 3.1% vs. 17.9%, all P〈0.05]. Conclusions The early, fully and permanent open of the infraction-related artery can effectively inhibit the left ventricular remodeling process, prevent LVA formation, improve LV function and prognosis.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2010年第2期103-106,共4页
Chinese Journal of Geriatrics
基金
湖北省卫生厅基金（20090100）
作者简介
通信作者：傅向华，Email：fuxh999@hotmail．com
