朱华刚,贾若飞,孟帅,李响,杨铎,金泽宁

• 1:首都医科大学附属北京安贞医院急诊科

摘要(Abstract)：

目的评价冠状动脉侧支循环对于ST段抬高急性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心功能的影响。方法纳入2012年4月至2013年11月在北京安贞医院急诊科行急诊PCI的STEMI患者95例,入院后均急诊行冠状动脉造影,并行急诊介入治疗,成功开通罪犯血管。根据冠状动脉造影结果按Rentrop方法评价侧支循环情况,分为有侧支循环组(16例)和无侧支循环组(79例)。分别于术后24 h内和术后30 d应用超声心动图评价心功能情况。结果 PCI术后24 h内,有侧支循环组的左室射血分数明显高于无侧支循环组[(53.4±7.1)%比(47.1±8.4)%,P<0.05];有侧支循环组出现室壁瘤的比例低于无侧支循环组,但是差异无统计学意义[3例(18.8%)比29例(36.7%),P>0.05]。门诊随访术后30 d,有8例患者出现失访,均为无侧支循环组;超声结果显示,有侧支循环组的左心室射血分数依然明显高于无侧支循环组[(56.3±6.9)%比(49.5±8.9)%,P<0.05];体表心脏超声显示有侧支循环组出现室壁瘤的比例明显低于无侧支循环组[3例(18.8%)比36例(50.7%),P<0.05]。结论早期开放的侧支循环对于STEMI急诊PCI后患者的心功能具有保护作用。

关键词(KeyWords)： 冠状动脉疾病;心肌梗死;侧支循环

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱华刚,贾若飞,孟帅,李响,杨铎,金泽宁

参考文献(References)：

• [1]Wustmann K,Zbinden S,Windecker S,et al.Is there functional collateral fl ow during vascular occlusion in angiographically normal coronary arteries?Circulation,2003,107:2213-2220.
• [2]Pohl T,Seiler C,Billinger M,et al.Frequency distribution of collateral flow and factors influencing collateral channel development.Functional collateral channel measurement in 450patients with coronary artery disease.J Am Coll Cardiol,2001,38:1872-1878.
• [3]Steg PG,Kerner A,Mancini GBJ,et al.Impact of collateral fl ow to the occluded infarct-related artery on clinical outcomes in patients with recent myocardial infarction:A report from the randomized occluded artery trial.Circulation,2010,121:2724-2730.
• [4]Elsman P,van't Hof AW,de Boer MJ,et al.Role of collateral circulation in the acute phase of st-segment-elevation myocardial infarction treated with primary coronary intervention.European heart journal,2004,25:854-858.
• [5]Meier P,Hemingway H,Lansky AJ,et al.The impact of the coronary collateral circulation on mortality:A meta-analysis.European heart journal,2012,33:614-621.
• [6]Meier P,Lansky AJ,Fahy M,et al.The impact of the coronary collateral circulation on outcomes in patients with acute coronary syndromes:Results from the acuity trial.Heart,2013.
• [7]Thygesen K,Alpert JS,Jaffe AS,et al.Third universal defi nition of myocardial infarction.J Am Coll Cardiol,2012,60:1581-1598.
• [8]Peter Rentrop K,Cohen M,Blanke H,et al.Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects.J Am Coll Cardiol,1985,5:587-592.
• [9]Meier P,Schirmer SH,Lansky AJ,et al.The collateral circulation of the heart.BMC medicine,2013,11:143.
• [10]蒋捷,高炜,朱国英.生长因子应用于冠心病治疗的实验和临床研究现状.中国介入心脏病学杂志,2000,8:219.