论文部分内容阅读
目的:观察急性ST段抬高型前壁心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)前向心肌梗死溶栓试验血流3级(TIMI3级)患者左室功能的状况。方法:分析112例STEMI直接PCI患者的临床和影像资料,112例中心功能不全的患者52例(心功能不全组),心功能正常的患者60例(心功能正常组),资料数据采用logistic回归分析。结果:与心功能正常组相比,心功能不全组PCI后第1天和第2周,室壁运动减弱,左室射血分数(LVEF)和心排血指数(CI)降低,左室舒张末期直径(LVED)、左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)增加(P<0.01);与PCI术后第1天相比,术后第2周LVEF和CI增加,室壁运动改善(P<0.01)。与心功能KillipⅡ级的患者相比,心功能KillipⅢ～Ⅳ级的患者LVEF和CI降低,室壁运动减弱,LVED,LVEDV和LVESV增加(P<0.05)。相关分析显示,梗死前心绞痛、心肌灌注显影血流分级和室壁运动积分是前壁STEMI直接PCI前向血流TIMI3级心功能不全的相关因素(P=0.04)。结论:前壁STEMI直接PCI前向血流TIMI3级,微循环功能障碍的患者收缩和舒张功能降低,左室扩张,其LVEF的提高可能是通过左室扩张来代偿的。
OBJECTIVE: To observe the left ventricular function in acute grade III anterior wall myocardial infarction (STEMI) and direct percutaneous coronary intervention (PCI) before myocardial infarction thrombolysis in grade 3 (TIMI 3) patients. Methods: The clinical and imaging data of 112 patients with STEMI direct PCI were analyzed. Among the 112 patients with central dysfunction, 52 patients (cardiac dysfunction group) and 60 patients with normal cardiac function (normal cardiac function group), the data were analyzed by logistic regression analysis. Results: Compared with the normal cardiac function group, the ventricular wall motion decreased, the left ventricular ejection fraction (LVEF) and the cardiac output index (CI) decreased, and the left ventricular diastolic pressure LVED, LVEDV and LVESV increased (P <0.01). Compared with the first day after PCI, LVEF and CI increased at the second week after PCI, Wall motion improved (P <0.01). Compared with patients with Killip class Ⅱ, LVEF and CI decreased, wall motion decreased, LVED, LVEDV and LVESV increased in patients with Killip Ⅲ ~ Ⅳ cardiac function (P <0.05). Correlation analysis showed that pre-infarction angina, myocardial perfusion imaging and ventricular wall motion score were correlated with TIMI3-level cardiac dysfunction in the anterior wall of STEMI direct anterior PCI (P = 0.04). CONCLUSIONS: The anterior wall STEMI direct PCI is associated with a decrease in TIMI grade 3 and microcirculation dysfunction in patients with impaired systolic and diastolic function and left ventricular dilatation. The increase in LVEF may be compensated by left ventricular dilatation.