经皮冠状动脉腔内成形术对冬眠心肌收缩功能的近期影响Short-term effect of percutaneous transluminal coronary angioplasty on contractile function of hibernating myocardium
杜志民,罗初凡,胡承恒,李怡,伍贵富,马虹
摘要(Abstract)：
目的 探讨经皮冠状动脉腔内成形术 (PTCA)对冬眠心肌收缩功能的近期影响。方法 对 5 3例存在节段心肌收缩功能不全的冠心病患者行超声心动图和核素心肌显像 (SPECT) ,PTCA术后1周复查超声心动图 ,比较手术前后左室整体及节段的收缩功能变化。结果 (1)术前收缩功能不全而经PTCA获得血运重建的 16 7个节段中 ,术后有 87段 (5 2 1% )功能改善 ;而未经PTCA获得血运重建的 5 9个节段中 ,术后仅有 2段 (3 4% )功能好转 (P <0 0 0 1)。血运重建区域的室壁运动指数(WMSI)从术前的 1 85± 0 96降至术后的 1 5 1± 0 80 (P <0 0 0 1) ,而非血运重建区域的WMSI在手术前后差异无显著性。 (2 )有节段收缩功能改善的患者左室射血分数 (LVEF)从术前的 5 2 1± 11 9提高至术后的 5 4 8± 11 2 (P <0 0 5 ) ,而无节段功能改善者LVEF手术前后差异无显著性 ;术后近期LVEF的提高幅度与左室整体WMSI的降低程度呈显著正相关 (r =0 73,P <0 0 0 1)。结论 成功PTCA术能在近期内改善冬眠心肌的收缩功能 ,且左室整体泵功能的变化与冬眠心肌收缩功能密切相关。
关键词(KeyWords)： 血管成形术,经腔,经皮冠状动脉;心肌冬眠;心室功能,左
基金项目(Foundation): 广东省科委科技攻关基金资助项目 ( 982 780 3)
作者(Author): 杜志民,罗初凡,胡承恒,李怡,伍贵富,马虹
参考文献(References)：
- 1RahimtoolaS .Aperspectiveonthethreelargemulticenterrandomizedclinicaltrialsofcoronarybypasssurgeryforstableangina.Circulation,1985,72(SupplV):V123V135.
- 2MarwickTH ,MacintyreWJ,LafontA ,etal.Metabolicresponsesofhibernatingandinfarctedmyocardiumtorevascularization.Afollow upstudyofregionalperfusion,function,andmetabolism.Circulation,1992,85:13471353.
- 3FathOrdoubadiF ,BeattKJ,SpyrouN ,etal.Efficacyofcoronaryangioplastyforthetreatmentofhibernatingmyocardium.Heart,1999,82:210216.
- 4霍勇,杨丽华,魏嘉平,等.小剂量多巴酚丁胺超声心动图对存活心肌及介入治疗的评价.中国介入心脏病学杂志,2000,8:35.
- 5SchillerNB ,ShahPM ,CrawfordM ,etal.AmericanSocietyofEchocardiographyCommitteeonStandards(SubcommitteeonQuantificationofTwoDimensionalEchocardiograms).Recommendationsofquantificationoftheleftventriclebytwo dimensionalechocardography.JAmSocEchocardiogr,1989,2:358367.
- 6TopolEJ ,WeissJL ,GuzmanPA ,etal.Immediateimprovementofdysfunctionalmyocardialsegmentsaftercoronaryrevascularization:detectionbyintraoperativetransesophegealechocardiography.JAmCollCardiol,1984,4:11231134.
- 7LaCannaG ,AlfieriO ,GiubbiniR ,etal.Echocardiographyduringinfusionofdobutamineforidentificationofreversibledysfunctioninpatientswithchroniccoronaryarterydisease.JAmCollCardiol,1994,23:617626.
- 8RambaldiR ,HamburgerJN ,GeleijnseML ,etal.Earlyrecoveryofwallmotionabnormalitiesafterrecanalizationofchronictotallyoccludedcoronaryarteries:adobutamineechocardiographic,prospective,single centerexperience.AmHeartJ,1998,136:831836.
- 9AfridiI,QureshiU ,KopelenHA ,etal.Serialchangesinresponseofhibernatingmyocardiumtoinotropicstimulationafterrevascularization:adobutamineechocardiographicstudy.JAmCollCardiol,1997,30:12331240.