急性心肌梗死患者经急诊介入治疗后心肌顿抑的临床观察

目的探讨急性心肌梗死患者经急诊介入治疗后心肌顿抑发生情况，为急性期心功能的维护提供依据。方法筛选62例首次急性前壁及前间壁心肌梗死患者，其中男性43例，女性19例，年龄47—72岁，平均年龄58．76岁。32例行急诊冠状动脉介入治疗（PCI组），30例为内科保守治疗患者（药物治疗组），于术后或入院后0（即刻）～2d及10～14d静息状态下分别行超声心动图检查，记录左心室内径（舒张末前后径）、心输出量及左心室射血分数，同时监测肌酸激酶、肌酸激酶同工酶、肌钙蛋白T，找出酶峰值。结果与药物治疗组比较，PCI组术后0（即刻）-2d左心室内径明显增加（P〈0．01），心输出量明显减少（P〈0．01），左心室射血分数明显降低（P〈0．01），心肌酶峰值提前出现，且低于药物治疗组酶峰值（P〈0．05）；治疗前后比较，PCI组术后10。14d较前左心室内径明显减小（P〈0．01），心输出量增加（P〈0．05），左心室射血分数明显升高（P〈0．01），而药物治疗组入院后10-14d较治疗前左心室内径、心输出量及左心室射血分数无显著变化（P〉0．05）。结论急性心肌梗死患者行急诊PCI治疗可有效减少心肌坏死面积，但存在心肌顿抑，因此术后心功能的维护非常重要。

Clinical Observation of myocardial stunning after emergency interventional therapy in acute myocardial infarction

Objective To investigate the condition of myocardial stunning after emergency interventional therapy in the patient with acute myocardial infarction （AMI）,and provide scientific basis for managing cardiac function in acute stage. Methods A total of 62 patients with anterior wall acute myocardial infarction and anteroseptal wall myocardial infarction at first onset, male 43, female 19, aged 47 - 72 years, mean age 58.76 years, divided into 2 groups PCI group 32 cases treated with percutaneous coronary intervention; medicated group 30 cases treated with conservative medical treatment. The echocardiography were performed in resting state. All of the examinationswere performed afteroperation oradmission 0- 2 d, and 10-14d.The left ventricular diameter（LVD,end-diastolic anteroposterior diameter）, cardiac output（CO）, left ventricular ejection fraction（LVEF） were recorded at the same time,and the creatine kinase （CK）, CK isoenzyme, Treponin T were monitored observation of the enzymic peak value, calculation of mean value and standard deviation, and t test were performed. Results Compared with the medicated group, in PCI group, LVD significantly increased（P 〈 0.01）; CO decreased obviously （P 〈 0.01）, and LVEF obviously decreased （P〈 0.01）, and the enzymic peak value occurred earlier and lower than that of the medicated group （P〈 0.05） were found. Compared with before-after-treatment, LVD decreased obviously postoperation 10 - 14 d than preoperation（P 〈 0.01）, CO increased（P〈 0.01） and LVEF improved obviously（P〈 0.01） were found; but there was no significant difference between admission 10- 14dandadmission 0-2d （P〉 0.05）. Conclusion h is demonstrated that the patient with AMI treated by emergency PCI can reduce the myocardial necrosis areas effectively, hut myocardial stunning still exists. This study shows that it is very important to protect the cardiac function after operation.