经皮冠状动脉介入治疗对急性前壁心肌梗死患者左心室功能作用的临床研究

目的 :探讨经皮冠状动脉介入治疗对急性前壁心肌梗死患者左心室功能的影响 ,以指导对其合理的治疗。方法 :选择首次Q波急性心肌梗死 (AMI)的患者 5 3例 ,随机分为介入治疗组 (A组 )和药物治疗组 (B组 ) ,A组病人于AMI后 2～ 4周行冠脉造影并证实存在梗塞相关血管 (IRA)而行经皮冠状动脉腔内成形术 (PTCA)及支架植入术 ,其他治疗同B组。常规检查血压、血糖、血脂、心肌酶谱、心电图及超声心动图等 ,并于半年后复查 ,随访半年内心脏事件发生情况。超声心动图主要观察室壁运动指数 (WMI)、左室射血分数 (LVEF)、左室中部的最大收缩期流速 (Vp)及二尖瓣舒张晚期与早期峰值流速之比值 (A/E)。结果 :A组的 3 2例病人PTCA及支架植入均获成功 ,且达 3级TIMI血流。半年后 ,A、B组各失访 2例 ,剩余病人中 ,A组 (3 0人 )和B组 (19人 )随访前后在心率、血压、血糖及血脂方面无明显差异 (P >0 .0 5 )。与梗塞后 2～ 4周比较 ,B组Vp、A/E、WMI及LVEF无改善(P >0 .0 5 ) ,而A组Vp、A/E及WMI均有显著改善 (P<0 .0 5 ) ;半年后 ,B组病人再梗塞、室壁瘤形成及心功能(NYHA)ⅢⅣ级者均高于A组 (P <0 .0 5及P <0 .0 1) ;A组与B组比较 ,Vp、A/E、WMI及LVEF均存在明显差异 (P <0 .0 5及P <0 .0 1) ,但两组不稳定型心绞痛发生率

A Clinical Study on the Impact of Percutaneous Coronary Interventions on Left Ventricular Function in the Patients With Acute Myocardial Infarction

Objective: We studied the impact of percutaneous coronary interventions(PCI) on left ventricular function in the patients with acute myocardial infarction(AMI), in order to direct the treatment of AMI. Methods: Fifty three patients with Q wave AMI were randomly divided into group A treated with percuteneous transluminal coronary angioplasty(PTCA) and group B treated with drugs.The cases in group A were assigned to undergo coronary angiography after 2 to 4 weeks of AMI and had infarct related arteries, then they successfully underwent PTCA,the drugs of the both groups were similar.Blood pressure,fasting blood glucose(FBG),blood lipid, myocardial enzyme,electrocardiography(ECG) and echocardiography were mesured after treatment and once again after 6 months.The cardiac events were registered during 6 month clinical follow up.The wall motion indice(WMI),left ventricular ejection fraction(LVEF), peak velocity of middle part of left ventricle(Vp) and the ratio of A peak velocity and E peak velocity of mitral valve(A/E) were obtained by echocardiography. Results: Thirty two cases in group A successfully underwent PTCA and stent implantation and attained TIMI flow of grade 3. Two cases were lost for follow up in group A and 2 patients were lost in group B.Thirty cases remained in group A and 19 in group B were similar in age,sex,heart rate,mean artery pressure(MAP),FBG and blood lipid(P>0.05).After 6 months,the cases of myocardial re infarction, left ventricular aneurysm and NYHA of 3 to 4 grade of heart function were more in group B(P<0.05 or P<0.01).Compared with 2 to 4 week,the Vp,A/E,WMI and LVEF have not been improved(P>0.05) in group B, the Vp,A/E and WMI were obviously improved in group A(P<0.05). After 6 months,compared with group B, the Vp,A/E,WMI and LVEF were obviously improved(P<0.05 or P<0.01) in group A;however,the cases with unstable angina of the both groups were similar(P>0.05). Conclusion: Successful percutaneous coronary interventions(PCI) was benefit to the improvement of prognosis in patients with Q wave AMI.