急性心肌梗死晚期再灌注对左室重构及心功能的影响

目的　探讨Q波型前壁心肌梗死恢复期开通梗死相关冠状动脉对左室重构 (LVRM )及心功能的影响。方法　选择 4 0例近期首次发生过Q波型前壁心肌梗死且造影显示供血区供血冠状动脉闭塞者作为研究对象 ,按前瞻性随机方式分组 ,治疗组患者心肌梗死后 4周内行冠状动脉内支架置入术 ;对照组患者心肌梗死后不作支架术。均于梗死后 4周和 2 4周进行超声心动图观察。分别测定左室舒张末期容量(LVEDV)、左室收缩末期容量 (LVESV)、左室射血分数 (LVEF)。结果　心肌梗死后均可发生明显左室重构 ;治疗组 2 4周与 4周时对比 ,LVEDV与LVESV均减小 (P <0 .0 5 ) ,而LVEF升高 (P <0 .0 5 ) ,LVRM与心功能明显改善 ,治疗组 2 4周时与对照组比较 ,以上指标有显著性差异 (P <0 .0 5 ) ;对照组 2 4周与梗死后 4周比较无显著性差异 (P >0 .0 5 )。结论　晚期恢复梗死相关动脉可明显减轻或逆转Q波型前壁心肌梗死患者的LVRM ,明显改善左心室功能。

Effects of advanced reperfusion of acute myocardial infarction on left ventricular remodeling and cardiac function

Objective To evaluate the effects of infarction recanalizing related coronary artery(IRCA) on the left ventricular remodeling(LVRM) and cardiac function during the recovery phase of acute Q-wave myocardial infarction.Methods 40 patients with first acute Q-wave myocardial infarction whose IRCA were ocduded were divided into two groups,canalizing group and non-canalizing group.Echocardialgraph was applied to observe all cases in 4 weeks and 24 weeks after myocardial infarction,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and letf ventricular ejection fraction(LVEF) were measured.Results LVRM occurred in all patients after MI.LVEDV and LVESV were decreased(P<0.05),but LVEF was in creased (P<0.05) and LVRM and cardiac function were remarkably improved in treatment sroup at 24 week compared with thoses at 4 week.Above-mentioned indexes were signifieantly different in treatment sroup at 24 week from those in control group(P<0.05).LVEDV and LVESV at 24 week in control sroup were not significantly different from those at 4 week following infarction(P>0.05).Conclusion The canalizing of IRCA during recovery phase of acute Q-wave myocardial infarction could prevent LVRM and improve left ventricular function.