冠脉介入治疗后心肌梗死区灌注程度及存活对左室重构及功能的影响

评价冠脉介入治疗（PCI）后核素显像心肌梗死区灌注程度及存活对左室重构及功能的影响。选取20例急性前壁心肌梗死患者,男18例,女2例。梗死后20h内,梗死相关血管已接受冠状动脉介入治疗,冠脉血流正常。所有患者PCI术后10天内接受静息状态下双核素心肌显像（心肌灌注及心肌代谢显像）。根据基线梗死区灌注减低程度和心肌有无存活,分为两组,通过超声心动观察不同组患者12个月后左室舒张末直径（LVEDD）及左室收缩功能（LVEF）的变化,观察梗死区心肌存活状态及灌注情况对于左室重构的影响,间接反映其对自身心肌干细胞修复功能的影响。结果表明,梗死心肌有存活的患者（n=10）与无存活组（n=10）相比,两组12个月后LVEDD都无明显变化。梗死心肌有存活的患者LVEF有所改善,43.6±7.83 vs.46.79±12.68,无存活组LVEF轻度下降,39.10±8.71 vs.37.70±7.57,P〉0.05。梗死区灌注减低程度不同的两组患者PCI术后12个月,LVEDD都无明显变化。LAD PER%〈50%组（n=9）LVEF值有所改善,39.89±10.19%vs.42.22±13.54%,但变化不具有显著性,P〉0.05;LAD PER%〉50%组（n=11）LVEF值无改善,并可见轻度下降,42.55±6.86%vs.41.20±8.32%。LAD PER%〈50%且同时梗死区有存活心肌的患者（n=5）LVEF改善明显,上升了4.8%,与LAD PER%〉50%且同时梗死区无存活心肌的患者（n=6）相比具有统计学意义,P=0.029。结论：急性前壁心肌梗死并行PCI治疗的患者,心肌灌注程度不同与梗死区心肌是否有存活都对患者的左室重构改善无明显影响,但心肌灌注程度较好的患者和有心肌存活的患者左室收缩功能都有轻度改善;尤其值得注意的是,在心肌灌注程度较好,并且有存活心肌存在的情况下,心功能改善明显。而相对梗死区灌注差且无心肌存活的患者,12个月后,心功能减低,左室重构更加明显。

Impact of Regional Perfusion and Viability of Infracted Area on Left Ventricular Remodeling and Function in Patients after PCI Therapy

To evaluate the impact of regional perfusion and viability of infracted area on left ventricular remodeling and function in patient after percutaneous coronary intervention(PCI) therapy,twenty anterior myocardial infarction patients with PCI in 20 hours were involved,whose CAG coronary blood flows have been normal.Rest DISA SPECT imagines were performed in 10 days after PCI.According to the myocardium viability and the baseline severity of perfusion in the infracted area(LAD extent %),the patients were divi...