摘要
目的探讨不同时间段行经皮冠脉介入治疗（PCI）对急性·心肌梗死后左室重构和心功能的影响。方法随机抽取65例以首次急性心肌梗死入院并接受PCI治疗的患者，按照症状出现到行PCI的时间进行分组：早期组、晚期组、择期组。所有患者入院后均给予抗凝、抗血小板、抗缺血基础药物治疗，并于住院期间（平均住院日约7d）及心肌梗死后6个月内行心脏超声检查，测定左室舒张束内径（LVEDD）、左室射血分数（LVEF），判断心室重构情况及左室功能，比较分析其结果。结果①住院期间早期组的心功能LVEF明显好于其他两组（P〈0.05）；随访6个月3组间心功能无明显差异。②无论住院期间还是随访6个月，3组之间LVEDD差异不明显。③早期组随访半年比住院期间的LVEDD有明显缩小（P〈0．05）。④亚组分析：43例前壁梗患者早期组住院期间的心功能仍高于晚期组和择期组，且早期组的LVEDD仍明显缩小；择期组住院期间及随访6个月的LVEDD值均大于晚期组。8例室壁瘤形成中有7例（87．5％）发生在前壁心肌梗死，1例发生在下壁心肌梗死。结论早期PcI可明显改善STEMI患者住院期间心功能情况，并可显著改善左室重构。对于前壁心肌梗死，晚期PCI较择期PCI更明显改善左室重构。
Objectives To investigate the effects of PCI time on left ventricular remodeling ＇after acute myocardial infarction. Methods It was conducted a randomized study involving 65 patients with first ST-elevation myocardial infarction admitted in our hospital and all the patients were assigned to routine PCI and stenting with optimal medical therapy. According to the time,PC! was performed,the patients were divided into three groups：early PCI,late PCI and selectively PCI. All the patients were performed echocardiography at discharging and 6 months after the AMI. The echocardiographic findings were analyzed and the left ventricular ejection fraction（LVEF） and the left ventricular end-diastolic diameter（LVEDD） were compared. Results ①The patients＇heart function of early PCI group was superior to the other groups at discharging. There was no statistically significant difference in the LVEF after a 6 months follow-up between the three groups.②No signifi- cant difference in LVEDD was found between three groups both at discharging and 6 months. ③ In the early PCI group,the LVEDD obviously decreased after 6 months compared with that before discharging. ④Subgroup analysis ： the advantage of early PCI group in the patients with an- terior myocardial infarction was still exist. Worthy to note was that the LVEDD in selectively PCI group was larger than late PCI group both at discharging and at 6 months after AMI. Conclusion Early PCI could obviously improve the cardiac function and left ventricular remodeling of patients with acute myocardial infarction. For the patients with anterior myocardial infarction,late PCI is superior to selectively PCI in im- proving ventricular remodeling. It is recommend an earlier PCI strategy （ late PCI ） for patients with acute anterior myocardial infarction who have missed the opportunity of early PCI.
出处
《潍坊医学院学报》
2012年第5期343-346,共4页
Acta Academiae Medicinae Weifang
