超声评价急诊PCI治疗STEMI患者左室舒张功能变化的临床研究

目的：：探讨急诊经皮冠状动脉内介入术( PCI)治疗对ST段抬高型心肌梗死( STEMI)患者左室舒张功能的影响,分析二尖瓣口血流舒张早期血流速度与组织多普勒运动速度比(E/E’)评价STEMI患者左室舒张功能的价值。方法：收集30例STEMI患者行急诊PCI治疗术前、术后即刻、术后两周及术后两月超声心动图资料,以及急诊PCI术前、术后即刻左室舒张末压力(LVEDP)。结果：STE-MI患者急诊PCI术后即刻、术后两周及术后两月与术前相比,左心室射血分数( LVEF)增高、侧壁E’减低,差异均有显著性(P<0.05)；PCI术后即刻E与术前相比减低,差异有统计学意义(P<0.05)；术后两周、术后两月与术后即刻、术前相比,左心房容积指数( LAVI)增大,差异有统计学意义( P<0.05)。 STE-MI患者二尖瓣环非梗死区的E/E’与急诊PCI术前所测的LVEDP 无相关性(P>0.05),与急诊PCI术后即刻所测LVEDP 无相关性(P>0.05)。结论：STEMI患者左室舒张功能在急诊PCI术后两周有减低趋势,LAVI在术后两周、两个月显著增大,E/E’与LVEDP 关系尚不确切。

Study on Ultrasonography in Evaluation of Changes in Left Ventricular Diastolic Function after Emergent PCI in STEMI Patients

Objective:To investigate the effect of emergent percutaneous coronary intervention ( PCI)on the left ventricular diastolic function in patients with ST elevation myocardial infarction ( STEMI) , to ana-lyze the ratio of the blood flow velocity in the early diastolic period in the mitral orifice to the velocity of move-ment of tissue doppler imaging ( E/E') , and to evaluate the values of left ventricular diastolic function in STE-MI patients. Methods:The echocardiogram data before, just after surgery, at 2 weeks after, and at 2 months after emergent PCI, and the left ventricular end-diastolic pressure (LVEDP) before and just after the emer-gent PCI in 30 STEMI patients were collected. Results: STEMI patients had significantly increased left ven-tricular ejection fraction ( LVEF) and significantly decreased E on the lateral wall just after, after 2 weeks, and after 2 months, the emergent PCI when compared with that before the surgery ( all P < 0.05); they had significantly decreased E just after PCI when compared with that before PCI ( P <0.05);and they had signifi-cantly increased left atrial volume index ( LAVI) at 2 weeks and 2 months after PCI when compared with that just after and before PCI ( P < 0.05) . The E/E' of the non- infarction zone in the mitral ring in the STEMI patients was insignificantly dependent on LVEDP determined before and just after the emergent PCI ( both P>0.05) . Conclusion:The STEMI patients have decreased left ventricular diastolic function at 2 weeks after e-mergent PCI, and significantly increased LAVI at 2 weeks and 2 months after the surgery. The relationship be-tween E/E' and LVEDP is not clear yet.