不同时间窗PCI术对急性心肌梗死患者预后的影响

目的比较在不同时间窗行直接经皮冠状动脉介入治疗（PCI）对急性心肌梗死（AMI）患者预后的影响。方法2007年1月至2008年9月连续入我院行直接PCI的AMI患者95例。按行直接PCI时间分为：AMI后A组（〈6h）45例，B组（6-12h）15例和C组（〉12h）35例。分别比较A、B、C三组的术后心衰发生率、总死亡率。于PCI后6个月行超声心动图检查，测定左室射血分数（LVEF）、左室舒张末期内径。结果住院和随访期间，A组的术后心衰发生率、总死亡率均明显低于B组和C组，而B组明显低于C组。差异有统计学意义（P〈0．05）。三组在术后6个月行超声心动图检查，A组的LVEF（％）（57．51±6．9）明显高于B组（52．25±4．27）和C组（47．75±6．86），差异有统计学意义（P〈0．05）。A组左室舒张末期内径（mm）（45．89±4．23）明显低于B组（49．0±3．1）和C组（52．46±4．9），差异有统计学意义（P〈0．05）。结论急性心肌梗死后行PCI术时间越早，患者心功能恢复效果越好，心衰发生率、左室重构和死亡率越低。

Comparison of the effect with different time windows on launching PCI in acute myocardial infarction patients

Objective To compare the influence of different time windows PCI on AMI patients. Methods Ninety-five consecutive AMI patients were enrolled from January 2007 to September 2008. According to the symptoms from the time of direct PCI, the patients were categorized into： 〈6 hour （group A） 45 patients, 6-12 hour （group B） 45 patients and 〉12 h （group C） 35 patients. Comparisons were made among the groups in the context of the incidence of heart failure after PCI and mortality. The left ventricular ejection fraction （LVEF） and left ventricular end-diastolic inside diameter（LVEDV） was determined by echocardiogram after 6 months. Results During the hospital and follow-up, PCI group A patients who underwent PCI had lower mortality rate than group B and group C. Group B had lower mortality rate than group C. The difference was significant （P〈0.05）. Compared with the LVEF（%） （52.25±4.27） in group B, and the LVEF（%） （47.75±6.86） in group C, the LVEF（%）（57.51± 6.90） in group A were significantly improved after 6 months （P〈0.05）. The LVEDV（mm） （45.89±4.23） in group A was significantly lower than the LVEDV （mrn）（49.0±3.1 ） in group B and the LVEDV （ram）（52.46±4.9） in group C （P〈0.05）. Conclusion The earlier time windows on launching PCI in AMI patients can significantly improve LV systolic function. The earlier time windows can reduce the incidence of heart failure and total mortality rate. The earlier time windows can inhibit left ventricular remodeling and improve left ventricular function and prognosis.