经皮冠状动脉介入术对冠心病患者心肌微循环灌注的影响

目的 探讨经皮冠状动脉介入术(PCI)对冠心病( CHD)患者心肌微循环灌注的影响.方法 经冠状动脉造影证实有冠状动脉狭窄的冠心病患者42例,在行PCI术前后均进行经静脉心肌声学造影(MCE)结合腺苷负荷检查,通过心肌显影程度定量判断冠状动脉微循环灌注情况并记录其图像,将PCI治疗前后心肌声学造影结果进行对比分析,评价PCI手术前后心肌微循环灌注情况,以便判断PCI手术疗效,估计患者预后.结果42例患者中39例患者成功完成PCI术,病变血管全部开通,重复造影示TIMI血流3级；灌注异常心肌节段治疗后局部所有毛细血管横截面积之和[A=(15.46±3.27)分]、血流速度[β=(0.75±0.16)分/s]、心肌血流量[A·β=(12.00±4.51)分2/s]均较治疗前[A=(6.68±1.76)分、β=(0.40±0.12)分/s、A·β=(2.82±1.38)分2/s]明显增加(t=37.25、27.58、30.65,均P＜0.05).3个月后随访,射血分数较治疗前明显增加(t=13.77,P＜0.01),室壁运动记分指数较治疗前明显下降(=8.75,P＜0.01).相关分析显示,PCI术后A、β、A·β相关性较强(均P＜0.01).结论 PCI术可有效改善心肌梗死患者心肌组织微循环灌注,尽早行PCI术,可以挽救梗死区的缺血心肌,改善左心室功能.

The effect of percutaneous coronary intervention on myocardial perfusion in coronary heart disease patients

Objective To evaluate the effect of percutaneous coronary intervention（PCI） on myocardial perfusion in coronary heart. Methods Fourty-two patients with coronary heart disease who were confirmed to have coronary artery stenosis by the coronary angiography were selected. They were checked by myocardial contrast echocardio-graphy of intravenous before and after treatment by PCI. Then we determined quantitatively the perfusion of coronary microcireulation based on the extent of myocardial imaging and recorded it images. The myocardial contrast echoear-diography result was compared before and after treatment by PCI for evaluating the situation of myocardial perfusion and effect of PCI. So we can estimate the patients＇ prognosis. Results There were 39 cases of 42 patients with PCI that their lesion vascular were all opening and unblocked. Repeated radiography showed that their TIMI blood flow was the third level. The partial cross sectional area of all the capillaries [ A = 15.46 ± 3.27 ） min ], blood flow velocity [ β = （0.75 -± 0.16 ）min/s ], and myocardial blood flow volume [ A ·β = （12.00 ± 4.51 ）min2/s ] dependent on myocardial segments all increased more significantly than those before the PCI[ A = （6.68 ± 1.76 ）min, 13 = （0.40 ± 0. 12 ）min/s, A ·β = （2.82 -± 1.38 ） min2/s ] （ t = 37.25,27.58,30.65,P 〈 0.05 ）. After PCI three months the EF value of follow-up patients was increased more than that of before PCI（ t = 13.77 ,P 〈 0.01 ） but the scoring index of ventricular wall motion was decreased more than that of before PCI（ t = 8.75 ,P 〈 0.01 ）. Correlation analysis showed that after PCI A, β, A ·β all had a strong correlation （ every P 〈 0.01 ）. Conclusion PCI could effectively improve the situation of myocardial perfusion in myocardial infarction patients. It could save isehemia myocardial in infarction field and also improve the function of left ventrieular if patients implemented PCI operation as soon as possible.