心肌呈色分级评价急性心肌梗死急诊经皮冠状动脉介入治疗的近期疗效Therapeutic efficacy of primary PCI in acute myocardial infarction evaluated by myocardial blushing grade
方毅民,任法新,杨军,于滨,刘少荣,刘文波,张传焕
摘要(Abstract)：
目的以心肌呈色分级(MBG)评估急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)后的心肌灌注状况。方法109例AMI患者给予急诊PCI治疗。各例于PCI后行冠状动脉造影,观察梗死相关动脉(IRA)前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率。结果冠状动脉造影结果显示,无复流组(no-reflow,NR)22例患者,占所有直接PCI患者的20.2%,既往心肌梗死史和糖尿病、前壁梗死和多支血管病变的发生率方面明显多于非NR组。NR组MBG2和3级和ST段抬高下降≥50%者显著少于非NR组,根据心肌酶估测的心肌梗死范围扩大(磷酸肌酸激酶为43.45±5.34g比27.48±4.47g,P<0.05),左心室射血分数显著降低(0.39±0.11比0.62±0.13,P<0.01);NR组总死亡率较非NR组有增加趋势,但差异无统计学意义;非致死性心力衰竭(22.7%比5.7%,P<0.05)和复合终点事件(35.0%比13.8%,P<0.05)的发生率无论住院期间还是随访6个月均明显增加,而两组在不稳定型心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡的发生率方面差异无统计学意义。结论出现NR者心肌微循环灌注不良,梗死范围大,心功能降低,预后差。
关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;心肌呈色分级
基金项目(Foundation):
作者(Author): 方毅民,任法新,杨军,于滨,刘少荣,刘文波,张传焕
参考文献(References)：
- 1The GUSTO Angiographic Investigators.The effects of tissue plasminogen activator,strptokinase or both on coronary artery patency,ventricular function and survival after acute myocardial infarction.N Engl J Med,1993,329:1615-1622.
- 2吕安康,沈卫峰.心肌梗塞溶栓试验血流分级的临床意义.国外医学·心血管疾病分册,1997,24:21-23.
- 3Van′t Hof AWJ,Liem AL,Suryapranata H,et al.Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction:myocardial blush grade.Circulation,1998,97:2302-2306.
- 4Berman DS,Kiat H,Train KV,et al.Technetium99msestamibi inthe assessment of chronic coronary artery disease.Semin Nucl Med,1991,21:190-212.
- 5邢启祟.根据丙酮酸激酶变化计算心肌梗塞量的临床及实验研究.中华心血管病杂志,1995,23:417-420.
- 6Morishima I,Sone T,Okumura K,et al.Angiographic no reflow phenomenon as a predictor of adverse long term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction.JAmColl Cardiol,2000,36:1202-1209.
- 7Iliceto S,Marangelli V,Marchese A,et al.Myocardial contrast echocardiography in acute myocardial infarction:pathophysiological background and clinical applications.Eur Heart J,1996,17:344-353.
- 8Ito H,Taniyama Y,Iwakura K.et al.Intravenous nicrorandil can preserve microvascular integrity and myocardial viabilityin patients with reperfused anterior wall myocardial infarction.J Am Coll Cardiol,1999,33:654-660.
- 9Henriques JPS,Zijlstra F,Ottervanger JP,et al.Incidence and clinical significance of distal embolisation during primary angioplastyfor acute myocardial infarction.Eur Heart J,2002,23:1112-1127.
- 10Wong CK,French JK,Krucoff MW,et al.Slowed ST-segment recovery despite earlyinfarct artery patencyin patients with Qwaves at the presentation of a first acute myocardial infarction.Implications of initial Qwaves on myocyte reperfusion.Eur Heart J,2002,23:1449-1455.