论文部分内容阅读
目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后无复流患者的临床特征、主要影响因素及其对心功能和预后的影响。方法:根据梗死相关动脉校正的TI MI血流记祯法(CTFC)将同期入院的AMI患者(267例)经PCI治疗后分为有复流组(205例)和无复流组(62例)。测量2组的心肌梗死面积、左心室收缩功能、舒张功能和同步性功能参数。结果:无复流组较有复流组,症状发作至球囊扩张时间显著延迟(17·01±11·33)∶(12·56±9·27)h,P<0·05;心肌酶肌酸激酶(CK)峰值明显增高(4283±3098)∶(2285±1586)I U/LP<0·01;糖尿病比例、侧支循环良好比例明显降低,无梗死前心绞痛的比例、室壁瘤发生率、Killip分级≥2级发生率明显增高,均P<0·05。直接支架术治疗可减少无复流的发生。采用Logistic多元回归分析发现,左前降支近段完全闭塞且无明显侧支循环和无梗死前心绞痛、病理性Q波导联数、心肌酶CK峰值为无复流的独立危险因素。99mTc-MIBI-SPECT心肌灌注断层显像显示无复流组心肌梗死面积显著大于有复流组,P<0·05。无复流患者的收缩功能与舒张功能均明显受损(P<0·05,P<0·01);心室收缩同步功能亦明显下降,术后并发症、死亡率均明显增加(均P<0·05)。结论:无复流现象的发生与左前降支近段闭塞且无明显侧支循环、病理性Q波导联数、CK峰值、无梗死前心绞痛明显相关;PCI后无复流现象增加梗死面积,影响AMI患者的心功能和预后。
Objective: To investigate the clinical features, main influencing factors and their effects on cardiac function and prognosis in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: According to TI MI blood flow recording method (CTFC) of infarction-related artery correction, 267 AMI patients admitted to the same hospital at the same period were divided into two groups: the re-flow group (205 cases) and the no-reflow group ). Myocardial infarct size, left ventricular systolic function, diastolic function, and synchrony functional parameters were measured in two groups. Results: Compared with patients in the no-reflow group, the time from the onset of symptoms to the time of balloon dilation was significantly delayed (17.01 ± 11.33) (12.56 ± 9.27) h, P <0.05; The peak of creatine kinase (CK) was significantly higher (4283 ± 3098): (2285 ± 1586) IU / LP <0.01; the proportion of diabetes mellitus and collateral circulation was significantly lower, the proportion of angina without infarction, Rate, Killip grade ≥ 2 significantly increased the incidence, both P <0 · 05. Direct stent treatment can reduce the incidence of no reflow. Logistic multivariate regression analysis showed that the proximal segment of the left anterior descending artery was completely occluded with no obvious collateral circulation and no infarction angina, the number of pathological Q waveguides and CK peak were independent risk factors for no-reflow. The 99mTc-MIBI-SPECT myocardial perfusion tomography showed that myocardial infarction size was significantly higher in the no-reflow group than in the reflow group (P <0.05). The systolic function and diastolic function were significantly impaired in patients with no-reflow (P <0.05, P <0.01), the systolic function of ventricular systolic function was significantly decreased, and the postoperative complications and mortality were significantly increased (all P < 0 · 05). Conclusion: The occurrence of no-reflow phenomenon is closely related to the proximal occlusion of the left anterior descending artery without significant collateral circulation, the number of pathological Q-waveguides, peak of CK, and angina without infarction. The no-reflow phenomenon increases infarct size after PCI, affecting AMI patients with cardiac function and prognosis.