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目的:探讨小剂量腺苷负荷超声(LDASE)对急性心肌梗死(AMI)行经皮冠状动脉(冠脉)介入治疗(PCI)的患者临床预后的预测价值。方法:将行PCI且术后一周内行LDASE检测的AMI患者79例,记录运动异常节段数LDASE检测前后心室壁运动,并根据LDASE检测前后左心室收缩功能改善情况,将注射腺苷后患者左心室射血分数(LVEF)增加≥5%为改善组,LVEF增加<5%为未改善组。出院后随访24个月,比较两组临床特点及主要不良心脏事件(MACE)即心源性死亡、新发或恶化的心力衰竭、再发非致死性心肌梗死的差异;采用logistic回归分析确定影响临床预后的危险因素。结果:2组AMI患者性别组成、平均年龄、血管开通后左心室舒张末期内径、LVEF、血浆B型脑钠肽水平及入院Killip分级差异无统计学意义(P>0.05)。两组患者随访24个月未改善组MACE发生率较改善组升高(43.24%vs14.29%);与改善组相比,未改善组患者新发或恶化的心力衰竭的发生率(14.29%vs 37.84%)、再发非致死性心肌梗死的发生率(0.00%vs 5.41%)均升高,差异均具有统计学意义(P<0.05)。通过对相关因素的logistic回归分析发现,小剂量腺苷负荷状态下LVEF增加<5%、改善节段数≤3是预测临床预后的独立危险因素(P<0.05)。结论:AMI患者冠脉介入治疗后早期行LDASE检测是评估再灌注治疗后左心室功能的有效方法,可用于急性心肌梗死介入治疗后心血管不良事件的早期预测。
Objective: To investigate the predictive value of low dose adenosine stress echocardiography (LDASE) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: A total of 79 patients with AMI underwent LDASE within one week after surgery were enrolled. The ventricular wall motion was recorded before and after LDASE. According to the improvement of left ventricular systolic function before and after LDASE, left ventricular LVEF increased ≥ 5% for the improvement group, LVEF increased <5% for the unmodified group. After discharge from hospital for 24 months, the clinical characteristics and major adverse cardiac events (MACE) were compared between the two groups, that is, cardiac death, new or worsening heart failure, and recurrence of non-fatal myocardial infarction; Logistic regression analysis was used to determine the impact Risk factors for clinical prognosis. Results: The sex composition, mean age, left ventricular end-diastolic diameter, LVEF, plasma B-type natriuretic peptide and admission Killip grade in AMI patients were not significantly different between the two groups (P> 0.05). Compared with the improvement group, the incidence of MACE in the two groups was significantly higher than that in the improvement group (24.29% vs 14.29%, 24.29% vs 14.29% vs 37.84%). The incidence of recurrent non-fatal myocardial infarction (0.00% vs 5.41%) was significantly higher than that of non-fatal myocardial infarction (P <0.05). Logistic regression analysis showed that the increase of LVEF was less than 5% under the condition of low dosage of adenosine load, and the improvement of the number of segments ≤3 was an independent risk factor for predicting clinical prognosis (P <0.05). Conclusions: LDASE detection in early AMI patients after PCI is an effective method to evaluate left ventricular function after reperfusion. It can be used for early prediction of adverse cardiovascular events after AMI.