早期再灌注对急性心肌梗死伴室壁瘤形成的阻抑效应和心功能改善作用的超声心动图观察

目的　超声心动图观察早期再灌注对急性心肌梗死伴室壁瘤形成的阻抑效应和心脏收缩功能改善作用。方法　发病 12h以内急性前壁心肌梗死伴室壁瘤形成患者 98例,随机分为经皮腔内冠状动脉成形术(PCI)组(36例)、溶栓组(31)例和常规药物治疗组(31例),三组患者均在治疗后 2周、12周、24周分别行超声心动图测量左室收缩末期容积(LVESV)、左室舒张末期容积 (LVEDV),并以体表面积校正为左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI),同时测左室射血分数 (LVEF)、局部室壁运动指数 (RWMI)、左室质量(LVM),后者与体表面积相除得到左室质量指数(LVMI),评价LVESVI、LVEDVI和心室收缩功能改善状况。结果　治疗后 2周,PCI组和溶栓组各参数优于药物治疗组,治疗后 12周,PCI组LVESVI、LVEDVI低于溶栓组(均P<0. 05),溶栓组各参数优于药物治疗组(均P<0. 05)。PCI组和溶栓组各参数自身前后比较明显改善(均P<0. 05),LVEF较 2周时显著增高(P<0. 05)。治疗后 24周,PCI组LVEDVI、LVESVI仍低于溶栓组(P<0. 05),PCI组和溶栓组各参数均优于药物治疗组 (均P<0. 05),PCI组LVESVI、LVEDVI、RWMI较 2周、12周均减小(均P<0. 05),LVEF较 2周、12周显著增高(均P<0. 05);溶栓组各时段比较与PCI组大致相同。结论　超声心动图

Evaluation of reversion and improvement of cardiac function on patients with left ventricular aneurysm following acute myocardial infarction by early reperfusion with echocardiography

Objective To study the reversion and improvement of cardiac systolic function on the patients with left ventricular aneurysm following acute myocardial infarction by early reperfusion with echocardiography.Methods Ninty-eight patients with left ventricular aneurysm following acute myocardial infarction within 12 hours were divided into three groups:percutaneous transluminal coronary angioplasty (PCI) group (36 cases),thrombolytic therapy group (31 cases) and routine therapy group (31 cases).Echocardiography was used to evaluate left ventricular end-systolic volume index (LVESVI),left ventricular end-diastolic volume index (LVEDVI),left ventricular mass index (LVMI),regional wall motion index (RWMI),left ventricular ejection fraction (LVEF) after 2,12,24 weeks of treatment.Results After 2 weeks of treatment,the parameters in PCI group and thrombolytic therapy group were better than those in routine therapy group.After 12 weeks, LVESVI,LVEDVI in PCI group were lower than those in thrombolytic therapy group.The parameters in PCI group and thrombolytic therapy group changed significantly(all P<(0.05)).After 24 weeks, LVEDVI and LVESVI in PCI group were still lower than those in thrombolytic therapy group.The parameters in PCI group improved compared with those at 2,12 weeks(all P<(0.05)).The parameters in thrombolytic therapy group changed as those in PCI group.Conclusions Echocardiography can evaluate effects of different treatments,and both PCI and thrombolytic therapy can reverse the formation of ventricular aneurysm and improve ventricular systolic function,and the former therapy is better than the latter therapy.