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1.
目的观察经皮经腔冠状动脉内移植自体外周血干细胞(PBSC)治疗急性心肌梗死(AMI)的疗效。方法自2003年11月至2005年1月共入选AMI患者70例,随机分为干细胞移植组和对照组,两组均为35例。干细胞治疗组在常规AMI治疗(药物与介入治疗)基础上应用粒细胞集落刺激因子(GCSF)皮下注射动员自体骨髄干细胞,连用5天,第6天分离外周血干细胞悬液,将采集后的干细胞悬液经OVERTHEWIRE球囊导管中心腔注入梗死相关动脉(IRA),进行外周血干细胞移植;对照组经AMI常规方法(药物与介入)治疗。在外周血干细胞动员、采集及经冠状动脉回输过程中观察其不良反应。两组患者在移植前及移植后6个月应用超声心动图评价左室形态及心功能变化,室壁节段性运动积分;比较两组患者生存率及心脏事件发生率。结果6个月时干细胞移植组心脏收缩末容积(ESV)明显减小[(63.8±23.9)ML比(52.6±20.3)ML,P=0.01],舒张末容积(EDV)无显著性变化[(134.2±36.7)ML比(119.2±30.3)ML,P=0.07];左室射血分数(LVEF)显著增高[(50.0±8.2)%比(57.1±7.8)%,P<0.001];左室壁节段性运动积分指数(WMSI)明显减低[(1.219±0.190)比(1.101±0.118),P<0.001]。对照组介入术前及术后6个月随访ESV、EDV、LVEF及WMSI均无统计学差异(P=0.490、0.259、0.117、0.395)。两组术后6个月生存率及心脏事件发生率无统计学差异。不良反应:在PBSC动员、分离、采集及回输中总的不良反应共25例次,其中动员时不良反应占37.1%(13/35),分离和采集中的不良反应占14.3%(5/35),经冠状动脉回输过程中出现的不良反应占20.0%(7/35)。结论经皮经腔冠状动脉内移植自体PBSC治疗AMI可以在近期有效地减少心肌梗死缺血面积,减轻左室重构,改善心功能。  相似文献   

2.
目的通过评价急性心肌梗死(AMI)后延迟冠状动脉介入治疗(PCI)对左室重塑、心功能的影响,并分析随访资料,探讨AMI延迟PCI的临床意义.方法 25例PCI病人为治疗组,同期未行PCI的19例病人为对照组,于基线、1个月及6个月3个时间点进行同位素心肌灌注显像检查,同时进行临床资料随访.结果①两组间对左室舒张末容积(EDV)、左室收缩末容积(ESV)及左室射血分数(LVEF)无统计学意义,且不同时间段比较,EDV、ESV及LVEF在不同时间段间无统计意义;EDV、ESV、LVEF各组的不同时间段与治疗方法间无交互作用.②临床事件随访时间6个月~16个月,治疗组复合事件(包括死亡、心肌梗死、脑卒中、心力衰竭、心绞痛等)发生率较低(24.0% VS 57.9% P=0.02).结论AMI后延迟PCI治疗的心脏复合事件发生率较低,但对左室重塑并未显示有利作用,其意义需要进一步大规模临床试验的观察.  相似文献   

3.
目的探讨超声心动图在老年急性肺栓塞(APE)患者治疗前后左心功能与结构变化中的评价。方法随机选取该院2013年2月至2014年11月住院治疗的老年APE患者(APE组)和性别、年龄相匹配的1∶1健康者(对照组)各34例。对比分析所有患者治疗前后常规超声心动图记录的心率、左右室舒张末内径(LVED/RVED)、肺动脉收缩压(PASP)及实时三维超声检测的左室舒张末容积(EDV)、收缩末容积(ESV)、心搏量(SV)及左室射血分数(LVEF)左室峰值排空率(PER)。结果 APE组治疗前、后的心率、RVED/LVED、EDV及ESV值均高于对照组,LVEF和PER值均低于对照组(P0.05);APE组治疗后的心率、LVEF及PER值均高于治疗前(P0.05),而RVED/LVED、PASP、EDV及ESV值均低于治疗前(P0.05);PASP与PER、LVEF呈显著负相关(r=-0.760、-0.608,P0.05);数据重复性分析发现,两组患者间的EDV、ESV、SV、LVEF和PER值均呈现显著正相关(均P=0.000)。结论实时三维超声心动图可有效评估老年肺栓塞患者治疗前后的左心功能与结构变化,具有较高的临床诊断价值。  相似文献   

4.
目的比较直接和延迟经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)后左室重构及心功能的影响。方法纳入2012年1月~2015年12月于重庆市开州区人民医院收治的108例AMI患者临床资料,按照治疗措施不同分为3组,直接组38例(行直接PCI治疗),延迟组35例(行延迟PCI治疗),对照组36例(行保守治疗)。测定三组患者AMI治疗后1周、6个月的左室收缩末期容积(ESV)、左房内径(LAd)、舒张末期容积(EDV)、左室射血分数(LVEF),观测AMI后1周、6个月时血流动力学指标:肺动脉平均压(m PAP)、平均二尖瓣压力差(m MPG),并记录患者6个月内复发情况。结果治疗后6个月,直接组和延迟组LAd、ESV、EDV均低于对照组,且直接组LAd(34.04±5.10)mm、ESV(46.01±15.40)ml、EDV(114.24±25.68)ml均较延迟组低,各组间比较差异均具有统计学意义(P0.05);直接组和延迟组治疗后6个月LVEF均显著高于对照组,且直接组LVEF(60.41%±10.06%)高于延迟组,差异具有统计学意义(P0.05);治疗后6个月直接组和延迟组m PAP、m MPG均低于对照组,且直接组m PAP(4.36±0.51)P/k D、m MPG(0.98±0.36)P/k D低于延迟组(P0.05);直接组在治疗后6个月内AMI再次发作7.89%,心力衰竭再住院2.63%,均显著低于对照组(P0.05)。结论直接和延迟PCI治疗均可改善AMI患者左室重构和心功能,且直接PCI效果更佳。  相似文献   

5.
目的:探讨急性心肌梗死(AMI)患者血浆大内皮素(ET)、N末端脑钠肽(NT-proBNP)水平和左室室壁瘤(LVA)形成之间的关系。方法:选择确诊的AMI患者136例,LVA组68例和对照组68例,用酶联免疫吸附分析(ELISA)法测定其血浆大ET、NT-proBNP,部分患者均行超声心动图检查测定左室舒张末内径、左室射血分数(LVEF)及室壁运动指数(WMSI),并行左室造影检查测定左室收缩末期容积和左室舒张末期容积,LVEF及左室室壁运动记分。结果:LVA组的血浆大ET、NT-proBNP水平(1.32±1.24)pmol/L、(1 871.08±1304.63)pmol/L显著高于对照组,差异有统计学意义(P<0.01);LVA的患者较对照组左室扩大及LVEF减低更为明显,差异具有统计学意义(P<0.01)。结论:血浆大ET、NT-proBNP水平增高与AMI后LVA形成可能相关。  相似文献   

6.
目的:探讨急性心肌梗死患者自体骨髓单个核细胞(BM-MNCs)经冠状动脉移植治疗对心功能的长期保护作用.方法:84例急性心肌梗死患者,急诊静脉溶栓或急诊介入治疗[经皮冠状动脉成形术(PTCA)加支架置入]后2周内行择期介入治疗.84例中50例作为细胞治疗组,抽取骨髓40 ml, 提取BM-MNCs,经冠状动脉注入;另34例作为对照组以同样方法注入20 ml的0.9%氯化钠溶液.所有患者均于发病1~2周(平均9.5 d)时(择期介入前)进行超声心动图检查和低剂量多巴酚丁胺超声心动图负荷试验,于发病6个月和1~5年时复查;并随访记录心血管事件发生率及病死率.结果:细胞治疗组患者5年临床随访心血管事件发生率及病死率均明显低于对照组,且心功能改善更加明显; 6个月复查时,2组患者左室射血分数(LVEF)和室壁运动记分指数(WMSI)、左室舒张末容积指数(EDVI)、左室收缩末容积指数(ESVI)、心排血指数(CI)、每搏量指数(SI)等心功能指标均较术前有明显改善(P<0.01),但细胞治疗组WMSI、LVEF、ESVI、CI等指标及负荷状态下WMSI(△WMSI)、LVEF(△LVEF)均较对照组改善得更明显(P<0.01);5年超声心动图复查时,细胞治疗组EDVI、CI及LVEF较术前明显改善(P<0.01),并明显优于对照组(P<0.01).结论:自体BM-MNCs治疗对梗死后心功能有长期保护作用.  相似文献   

7.
目的 :观察骨髓干细胞动员对急性心肌梗死 (AMI)患者左室重构的影响。方法 :4 8例AMI患者随机分为动员组 (2 5例 )和对照组 (2 3例 ) ,动员组连续 3d给予粒细胞集落刺激因子 (G CSF) 30 0 μg/d ,用2 0 1Tl静息—再分布心肌显像比较两组第 6d、 30d的梗死面积 ,超声心动图观察 72h内和 3个月的左室舒张末期容积指数 (LVEDVI)、收缩末期容积指数 (LVESVI)、室壁运动指数 (WMSI)、射血分数(LVEF)。结果 :动员组治疗后心肌梗死面积明显减少 (0 383± 0 0 77vs 0 5 6 1± 0 0 96 ,P <0 0 1) ,LVESVI减少 [(2 7 4 7± 7 86 )ml/m2 vs (34 5 0± 8 0 8)ml/m2 ,P <0 0 5 ],WMSI减少 (1 10± 0 11vs 2 2 6±0 14 ,P <0 0 1) ,LVEF增加 (0 5 9± 0 0 7vs 0 4 8± 0 0 7,P <0 0 1)。结论 :应用G CSF动员AMI患者自身骨髓干细胞可明显缩小心肌梗死面积及有效防治左室重构  相似文献   

8.
目的 评价 99m Tc- MIBI门控心肌灌注断层显像中测得的心功能参数对老年冠心病 (CHD)预后的评定。方法 对老年人冠心病非心肌梗死组 (CHD- NMI) 33例 ,陈旧心肌梗死组 1 3例 (CHD- OMI)及 1 2例正常对照组进行 99m Tc- MIBI门控心肌灌注断层显像 ,利用计数法测得左室舒张末期容积 (EDV)、左室收缩末期容积 (ESV)和左室射血分数 (LVEF)。测得心功能参数对照组与 CHD- NMI组比较有差异 (P<0 .0 5) ,CHD-NMI与 CHD- OMI组比较有显著差异 (P<0 .0 1 )。结论  EDV、ESV、LVEF是评价左室功能的重要指标 ,对 CHD的功能评价 ,疗效观察及预后的判定均有重要意义。  相似文献   

9.
急性心肌梗死后ST段持续抬高的临床观察   总被引:1,自引:0,他引:1  
目的探讨急性心肌梗死(AMI)后ST段持续抬高的临床意义。方法取AMI后ST段持续抬高的静息心电图40例(A组),以无ST段持续抬高的AMI患者48例为B组。两组均进行冠状动脉造影及左心室造影,并观察2组病例的左室收缩末期容积(ESV)、左室舒张末期容积(EDV)、左室射血分数(LVEF)、局部室壁运动情况及冠状动脉阻塞部位、程度。结果A组较B组LVEF减低(P<0.05)、ESV增大(P<0.01),冠状动脉完全闭塞、局部室壁无收缩或矛盾运动比例A组明显高于B组(P<0.01),而2组EDV、室壁瘤发生比例差异无显著性意义(P>0.05)。结论急性心肌梗死后ST段持续抬高与冠状动脉完全的闭塞、LVEF的显著降低、ESV的明显扩大直接相关;与室壁瘤、EDV无显著相关,是一种简而易行、无创伤的临床检测手段,对急性心肌梗死后患者的治疗和预后提供积极的帮助。  相似文献   

10.
左室功能和结构改变与心脏起搏器起搏比例的关系   总被引:3,自引:0,他引:3  
目的分析心脏起搏器植入后远期左室收缩功能和结构改变的特点及其与起搏比例的关系。方法共入选20例病人,其中植入VVI起搏器10例,DDD起搏器10例。采用双探头门控单电子发射计算机断层摄影系统测定病人植入起搏器3年~4年后自身心律状态时左室射血分数(LVEF)、左室舒张末容积(EDV)、左室收缩末容积(ESV)及每搏量(SV)。结果起搏器植入后远期EDV、ESV呈增高趋势,LVEF植入前为(61.5±14.2)%,植入后为(53.4±13.9)%呈降趋势,且植入后远期LVEF在≥50%与<50两亚组均呈下降趋势。结论起搏器植入后远期,可发生左室功能和结构重塑,表现为LVEF增高或降低和EDV增大或减小。EDV增大、LVEF降低与起搏心搏数呈正相关。  相似文献   

11.
BACKGROUND: Recently the potential of myocardial repair by transplantation of autologous bone marrow stem cells has been suggested. Whether the additional intracoronary transplantation of autologous peripheral blood stem cells (PBSC), which were mobilized by granulocyte-colony-stimulating factor (G-CSF), could safely improve myocardial function in patients with acute myocardial infarction (AMI) was investigated. METHODS AND RESULTS: Seventy-three patients with AMI who had successfully undergone percutaneous coronary intervention (PCI) were enrolled in the present prospective nonrandomized open-labeled study. Ten patients with elective PCI received G-CSF for 4 days followed by intracoronary PBSC transplantation. Thirty-two patients with primary PCI and 31 patients with recent AMI and elective PCI served as controls. The left ventricular (LV) function was evaluated using echocardiography and magnetic resonance imaging. G-CSF and intracoronary transplantation of PBSC did not incur any periprocedural myocardial damage. After 6 months, the LV ejection fraction was significantly improved in the cell therapy group. For 2 years of the follow-up period, there was no adverse clinical events, except one asymptomatic in-stent restenosis. However, comparable improvement of the LV ejection fraction was also identified in the primary PCI and elective PCI control groups. CONCLUSIONS: In the present study, additional intracoronary infusion of PBSC was safe and feasible for the patients with AMI who had undergone PCI, but did not lead to a significant improvement in LV function compared to standard reperfusion treatment.  相似文献   

12.
目的:观察经冠状动脉(冠脉)自体骨髓单个核细胞(mononuclear bone marrow cell,MBMC)移植对急性前壁心肌梗死患者心室重构、心肌组织血流灌注及左心室收缩功能的影响。方法:选取40例急性前壁心肌梗死患者,根据患者的意愿分干细胞移植组(20例,接受急诊经皮冠脉介入治疗 标准药物 经冠脉注入骨髓单个核细胞治疗)和常规治疗对照组(20例,接受急诊经皮冠脉介入治疗 标准药物治疗)。两组患者分别于术前、术后3个月、术后6个月进行6分钟步行实验、多谱勒心脏超声心动图、平衡法核素心血池显像(ENRA),并记录发病6个月内主要临床事件。结果:同常规治疗组相比,心室重构、心肌组织血流灌注及左心室收缩功能术后3个月各项指标两组无明显差异,术后6个月干细胞移植组较常规治疗组改善明显,有显著性差异(P<0.05)。结论:本研究提示自体骨髓单个核细胞经冠脉移植治疗急性心肌梗死是安全的,能改善患者心肌组织灌注、左心室收缩功能及优化心室重构。  相似文献   

13.
Tomaszuk-Kazberuk A  Musiał WJ  Dobrzycki S  Korecki J 《Kardiologia polska》2004,60(6):541-9; discussion 550-1
BACKGROUND: It has been shown that normalisation of elevated ST segment after primary percutaneous coronary interventions (PCI) is associated with the achievement of reperfusion at the tissue level. AIM: To assess prospectively the return of left ventricular (LV) systolic function and the outcome of patients with acute myocardial infarction (AMI), treated with primary PCI, in relation to the early normalisation of the ST segment. METHODS: The study group consisted of 110 consecutive patients (33 females, 77 males, mean age 56 years) with AMI who were successfully treated with primary PCI (TIMI flow grade 3 and residual stenosis <30%) within 12 hours from the onset of symptoms. The patients were divided into two groups according to normalisation or lack of normalisation of an elevated ST segment. The mean time from the onset of symptoms to the restoration of blood flow in an infarct-related artery (pain-to-balloon time) was similar in both groups. LV echocardiographic parameters (ejection fraction EF and wall motion score index WMSI) and clinical status directly after PCI as well as 3 and 6 months later were assessed. RESULTS: Directly after primary PCI, LV impairment (low EF and high WMSI) was significantly more often present in patients without rather than with ST segment normalisation. Afterwards, LVEF and WMSI improved significantly only in patients with ST segment normalisation whereas in the remaining patients no such improvement was observed. During 6-month follow-up period, major cardiac events (death, new AMI or need for revascularisation) occurred more frequently in patients without rather than with ST segment normalisation (p=0.03). CONCLUSIONS: 1. Rapid resolution of ST segment elevation following effective primary PCI identifies patients with a favourable outcome. 2. ST segment normalisation predicts a return of LV systolic function in patients with AMI treated with primary PCI.  相似文献   

14.
目的观察延迟经皮冠状动脉支架植入术(PCI)对急性心肌梗死患者左心室重构及心脏事件的影响。方法将经药物治疗后病情稳定的急性心肌梗死患者分成延迟PCI治疗+药物治疗组(A组)和单纯药物治疗组(B组)。在入院即刻、7d和180d采用超声心动描记术评价左心室整体功能,并进行比较。结果A组患者行PCI术后180d左心室射血分数(LVEF)及左心室舒张末期内径(LVESd)、左心室收缩末期内径(LVESd)等指标(58.49±6.65、45.20±5.15、32.04±8.55)与术后7d(51.69±5.00、47.77±3.10、37.57±5.92)相比,差异有统计学意义(P〈O.05),与B组术后180d(53.16±5.92、46.20±4.60、35.40±7.40)比较,差异均有统计学意义(均P〈0.05);PCI术后7d两组上述指标比较,差异无统计学意义(均P〉0.05)。讨论延迟PCI有助于防止左心室重构.改善心功能,使心脏不良事件明显下降。  相似文献   

15.
目的评价自体外周血干细胞移植对急性心肌梗死患者左室重构和心功能的影响。方法共有65例急性心肌梗死患者入选本项前瞻性、非随机、开放试验(其中35例患者为细胞移植组,30例为对照组)。两组患者均接受标准的介入治疗和药物治疗,细胞移植组的35例患者同时接受自体外周血干细胞移植。两组患者在移植前及移植后6个月应用超声心动观察左室形态、室壁运动情况及左室功能指标的变化。结果6个月后干细胞移植组术前后比较左室舒张末期容LVEDV)明显缩小[(136.4±14.9)ml比(120.6±19.6)ml,P〈0.01],左室收缩末期容量(LVESV)明显缩小[(84.5±18.9)ml比(70.5±14.9)ml,P〈0,01],左室射血分数(LVEF)明显增高[(48.8±7.2)%比(56.5±7.4)%,P〈0.01]。左室壁节段性运动指数(WMSI)明显降低[(1.41±0.21)比(1.10±0.15),P〈0.01];左室射血前时间/射血时间比值显著降低[(0.46±0.08)比(0.40±0.07),P〈0.01],左室舒张功能指标:舒张早期峰值速度(Em)增高,舒张晚期峰值速度(Am)降低,Em/Am增高。对照组治疗前后比较上述指标均有改善,但差异无统计学意义,两组术后上述指标比较差异有统计学意义。结论经皮经腔冠状动脉内自体干细胞移植术能明显改善急性心肌梗死患者的左室功能,减小左室容量,阻止或延缓左室重构,改善心功能。  相似文献   

16.
AIMS: We have recently shown in the randomized-controlled BOne marrOw transfer to enhance ST-elevation infarct regeneration (BOOST) trial that intracoronary autologous bone marrow cell (BMC) transfer improves left ventricular (LV) ejection fraction recovery in patients after acute myocardial infarction (AMI). However, the impact of BMC therapy on LV diastolic function in patients after AMI has remained uncertain. METHODS AND RESULTS: Using (tissue) Doppler echocardiography, we evaluated the effects of BMC transfer on LV diastolic function in patients enrolled in the BOOST trial. After successful primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (MI), patients were randomized to a control (n = 29) or BMC transfer group (n = 30). Diastolic function was determined 4.5+/-1.5 days after PCI, at 6 months, and at 18 months by measuring transmitral flow velocities (E/A ratio), diastolic myocardial velocities (Ea/Aa ratio), isovolumic relaxation time (IVRT), and deceleration time (DT). All analyses were performed in a blinded fashion. There was an overall effect of BMC transfer on E/A [0.33+/-0.12; 95% confidence interval (CI): 0.09-0.57; P = 0.008] and Ea/Aa ratios (0.29+/-0.14; 95% CI: 0.01-0.57; P = 0.04). In contrast, we found no effect of BMC transfer on DT (-5+/-14 ms; 95% CI: -33 to 22; P = 0.70), IVRT (-7+/-7 ms; 95% CI: -20 to 6; P = 0.29), and E/Ea ratio (0.35+/-0.14; 95% CI: -0.92 to 1.62; P = 0.57). CONCLUSION: Intracoronary autologous BMC transfer improves echocardiographic parameters of diastolic function in patients after AMI.  相似文献   

17.
The role of glucose-insulin-potassium (GIK) infusion in the management of acute coronary syndrome is controversial. Limited data are available on the effects of adjunctive high-dose GIK (30% glucose, 50 IU of insulin, 80 mEq of potassium chloride infused at 1.5 ml/kg/hour over 24 hours) on myocardial perfusion and left ventricular (LV) remodeling in patients treated with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction. In this prospective study, 73 patients were randomized to receive GIK infusion (n = 40) or saline (placebo, n = 33) in addition to standard therapy. The primary end points were myocardial perfusion after PCI and LV remodeling at 6 months. Thrombolysis In Myocardial Infarction frame count and myocardial blush grade were evaluated before and after reperfusion treatment. LV end-diastolic and end-systolic volumes, ejection fraction, and wall motion score index were assessed in each patient after PCI and after 6 months. Although no differences in final Thrombolysis In Myocardial Infarction flow were observed between the 2 groups, myocardial blush grade 3 was more frequently achieved in the GIK group (p <0.05). At 6 months, ventricular remodeling was more often observed in the control group (24% vs 3%, p <0.05). In conclusion, GIK infusion in adjunct to primary PCI in patients with ST-segment elevation myocardial infarction was safe, improved myocardial perfusion after revascularization, and was associated with less LV remodeling at follow-up.  相似文献   

18.
目的:探讨自体骨髓干细胞不同时间窗经梗死前降支移植对急性前壁心肌梗死患者心功能、心肌存活的影响及其安全性。方法:对36例急性前壁心肌梗死并行急诊PCI的患者分组。5天内细胞移植10例,10~15天内移植10例,余16例常规治疗。三组患者均于移植术前、术后6个月行SPECT双核素心肌显像、超声心动图、6min步行试验及动态心电图检查。结果:同常规治疗组相比,心肌存活、左室形态、心功能等各项指标术后6个月干细胞移植组较常规治疗组改善明显,有显著性差异(P0.05),而10~15天组较5天组优势更明显。结论:骨髓干细胞经冠脉移植治疗急性前壁心肌梗死可以显著改善左室收缩功能和心肌存活,但在时间窗上应选择10~15天更加合适。  相似文献   

19.
目的评价经皮冠状动脉介入治疗(PCI)急性心肌梗死恢复期对患者左室重构的临床作用。方法对50例首次心肌梗死患者,平均于发病(3.8±2.1)周行冠状动脉造影,并进行前瞻性研究。按梗死相关冠状动脉是否进行PCI及PCI成功与否分为PCI组(28例PCI成功患者)和对照组(22例未行PCI患者)。对PCI组患者,于术前[平均(4.5±3.3)d]及术后随访期[平均(6.9±1.3)个月]及对照组患者于相当于PCI组术前和随访期时间进行心脏超声检查,以评价左室容量和收缩及舒张功能的改变。结果PCI组术后随访期左室容量较术前减小、左室收缩功能明显改善,而左室舒张功能无明显变化。与对照组相比,PCI组随访期左室容量较小,而收缩及舒张功能明显好于对照组。结论在心肌梗死恢复期,PCI尚能阻止患者的左室重构,改善患者的远期左室功能,具明显临床有益作用。  相似文献   

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