王晶,陈韵岱,智光,陈练,刘宏斌,徐勇,周肖,金琴花,王峙峰,孙志军,刘长福,王锦达

• 1:中国人民解放军总医院心内科
• 2:首都医科大学北京安贞医院心内科

摘要(Abstract)：

目的应用心肌声学造影(MCE)评价急性前壁心肌梗死(AMI)患者急诊PCI围术期静脉应用腺苷对PCI术后心肌灌注的改善作用。方法连续入选解放军总医院2008年11月至2010年1月行急诊PCI术的急性前壁心肌梗死患者40例,分为对照组(17例)与腺苷组(23例)。腺苷组于PCI术前10min静脉给予腺苷(50μg·min-1·kg-1),持续3h。术后即刻观察心肌梗死溶栓实验(TIMI)血流,术后7d行心肌声学造影检查观察心肌灌注情况,普通超声心动图检查测定左室收缩功能,随访患者1个月,观察主要心血管事件发生情况。结果两组术后TIMI0～2级血流发生率差异无统计学意义(17.6%比11%,χ2=0.00,P>0.05)。腺苷组心肌灌注速度(β)较对照组增加(0.12±0.04比0.09±0.03,t=5.00,P<0.05),心肌灌注血流量(A·β)也高于对照组(0.75±0.40比0.52±0.26,t=3.61,P<0.05)。腺苷组有更多节段心肌恢复较高水平灌注(42.5%比17.3%,χ2=47.204,P<0.05)。腺苷组左室射血分数高于对照组[(50.87±5.57)%比(46.12±6.29)%,t=2.52,P<0.05)]。结论急诊PCI围术期静脉应用腺苷可有效改善急性前壁心肌梗死患者的心肌灌注,使更多心肌恢复高水平组织灌注,改善心功能,而心肌声学造影可准确、安全、有效地对PCI后心肌组织灌注的情况进行评价。

关键词(KeyWords)： 腺苷;心肌声学造影;经皮冠脉介入术;急性前壁心肌梗死;心肌灌注

Abstract:

Keywords:

基金项目(Foundation): 北京市教育委员会科技发展计划面上项目(KM200610025016)

作者(Author): 王晶,陈韵岱,智光,陈练,刘宏斌,徐勇,周肖,金琴花,王峙峰,孙志军,刘长福,王锦达

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