存活心肌对冠状动脉介入治疗疗效的影响

目的　探讨急性心肌梗死患者存活心肌对冠状动脉介入治疗 (PCI)的影响。方法　 2 8例首次急性心肌梗死且成功进行静脉溶栓治疗并证实冠脉血运再通的患者 ,心肌梗死后 1周行小剂量 (2 5～ 10μg·kg-1·min-1)多巴酚丁胺负荷超声心动图 (DSE)评价存活心肌。所有患者在心肌梗死后 3周行PCI治疗 ,12周定期随访超声心动图。根据DSE检查结果 ,将患者分为存活心肌组 (n =19)和无存活心肌组(n =9) ,用DSE观察、评价两组PCI治疗效果。结果　 1周后存活心肌组患者左室舒张末期容量指数(LVEDVI)与无存活心肌组患者无明显变化 (6 0± 2 4 / 6 7± 13,P >0 0 5 ) ;梗死后 12周 ,存活心肌组LVEDVI明显低于无存活心肌组 (6 7± 10 / 10 4± 13,P <0 0 1) ;存活心肌组患者 12周LVEDVI变化不明显。左室收缩末期容量指数 (LVESVI)无存活心肌组患者在 12周后增加 (4 6± 16 / 6 1± 13,P <0 0 5 ) ;存活心肌组患者LVESVI明显低于无存活心肌组患者 (35± 12 / 5 6± 13,P <0 0 1)。心肌梗死后 12周存活心肌组患者左室射血分数 (LVEF)明显高于无存活心肌组患者 (6 0± 10 / 5 2± 15 ,P <0 0 5 ) ;梗死后 12周 ,室壁运动积分指数(WMSI)存活心肌组低于无存活心肌组 (1 38± 0 2 1/ 1 5 5± 0 0 9,P <0 0 5 )。结论

Clinic study of the alive myocardium''''s effectiveness to perculaneous coronary intervention

Objective To study the effectiveness of alive myocardium in myocardial infarct to perculaneous coronary intervention(PCI).Methods Twenty-eight patients of acute myocardial infarct were performed low dose(2.5～10μg·kg -1 ·min -1 ) dobutamine stress echocardiography(DSE) to prove alive myocardium.All patients were performed PCI after 3 weeks,and followed up after 12 weeks.The patients were divided to two groups:group of alive myocardium(n=19) and group of no alive myocardium(n=9) according to the result of DSE,and to assess the effectiveness of PCI in two groups.Results No statistic significance was found in Left ventricle end diastole volume indication(LVEDVI) in two groups after 1 week(60±24/67±13,P>0.05);But statistic significance was found in it after 12 weeks between two groups,LVEDVI in group of alive myocardium were lower than that in group of no alive myocardium(67±10/104±13,P<0.01);No statistic significance was found in LVEDVI in group of alive myocardium between 1 week and 12 weeks;Left ventricle end systole volume indication(LVESVI) in group of no alive myocardium increased after 12 weeks(46±16/61±13,P<0.05);LVESVI in group of alive myocardium were lower than in group of no alive myocardium after 12 weeks(35±12/56±13,P<0.01);Left ventricle eject fraction(LVEF) in group of alive myocardium were higher than that in group of no alive myocardium after 12 weeks(60±10/52±15,P<0.05);Wall motion score index(WMSI) in group of alive myocardium were lower than that in group of no alive myocardium after 12 weeks(1.38±0.21/1.55±0.09,P<0.05).Conclusion Left ventricular remodeling aoours in group of no alive myocardium,the effectiveness of PCI is not good.