直接经皮腔内冠状动脉成形术及支架治疗对急性心肌梗死患者左心室重构和左心功能的影响——与尿激酶溶栓治疗对照Effect of primary percutaneous transluminal coronary angioplasty and stent implantation on left ventricular remodeling and function in patients with acute myocardial infarction:compared with thrombolytic therapy
任文林,胡大一,赵远华,李瑞杰,薛松维,梁玉清,曹永革,张晓红,张平娜,陈玻 ,彭夫松
摘要(Abstract)：
目的 观察和评价直接经皮腔内冠状动脉成形术 (PTCA)及支架治疗对急性心肌梗死患者左心室重构和左心功能的影响。方法 对初次发病、发病 12小时以内或 12～ 2 4小时之间仍有心肌缺血证据、且无溶栓禁忌症的患者 ,随机给予直接PTCA和尿激酶 (15 0万IU)溶栓治疗 ,于 2周、12周和 2 4周行二维超声心动图检查并记录有关心脏事件。结果 共入选 6 5例患者 ,男性 5 5例 ,女性 10例 ,平均年龄 5 8 95± 8 94岁。其中PTCA组 32例 ,血管再通率为 10 0 % ;溶栓组 33例 ,血管再通率为 75 76 %。 2周后PTCA组的左心室收缩末容积指数 (ESVI)、左心室舒张末容积指数 (EDVI)、左心室射血分数 (LVEF)和梗死区室壁运动指数 (RWMI)均显著优于溶栓组 (P <0 0 5 ,P <0 0 5 ,P <0 0 1,P<0 0 5 )。溶栓组 12周和 2 4周ESVI(P <0 0 1,P <0 0 1)、EDVI(P <0 0 5 ,P <0 0 1)、LVEF(P <0 0 5 ,P<0 0 1)、GWMI(P <0 0 1,P <0 0 1)以及RWMI(P <0 0 5 ,P <0 0 1)与 2周时比显著改善 ;PTCA组ESVI(P <0 0 1,P <0 0 1)、EDVI(P <0 0 1,P <0 0 1)、LVEF(P >0 0 5 ,P <0 0 5 )、GWMI(P <0 0 5 ,P <0 0 1)以及RWMI(P <0 0 5 ,P <0 0 5 )也有显著改善。至 2 4周时 ,PTCA组和溶栓组EDVI(P >0 0 5 )、LVEF(P >0 0
关键词(KeyWords)： 急性心肌梗死;直接经皮腔内冠脉成形;溶栓治疗;心室重构
基金项目(Foundation): 北京市朝阳区科研开发计划 (QK0 10 2 0 9)基金资助
作者(Author): 任文林,胡大一,赵远华,李瑞杰,薛松维,梁玉清,曹永革,张晓红,张平娜,陈玻 ,彭夫松
参考文献(References)：
- 1BrodieBR ,StuckeyTD ,WallTC ,etal.Improtanceoftimetoreperfusionfor30 dayandlatesurvivalandrecoveryofleftventricularfunctionafterprimaryangioplastyforacutemyocardialinfarction.JAmCollCardiol1998;32:13121319.
- 2MarinoP ,ZanollaL ,ZardiniP .Effectofstreptokinaseonleftventricularremodelingandfunctionaftermyocardialinfarction:theGISSItrial.JAmCollCardiol1989;14:1149.
- 3AleksanderD ,PopovicMD ,AlecsandarN ,etal.Acuteandlong termeffectsofthrombolysisafteranteriorwallacutemyocardialinfarctionwithserialassessmentofinfarctexpansionandlateventricularremodeling.AmJCardiol1996;77:446.
- 4曾勇,朱文玲,倪超,等.急性心肌梗塞静脉溶栓治疗改善左心室功能的作用.中华心血管病杂志1997;25:192194.
- 5StewartRE ,O′NeillWW .Directangioplastyforacutemyocardialinfarction.CurrOpinCardiol1995;10:367371.
- 6deBoreMJ ,SuryapranateH ,HoorntjeJC ,etal.Limitationofinfarctsizeandpreservationofleftventricularfunctionafterprimarycoronaryangioplastycomparedwithintravenousstreptokinaseinacutemyocardialinfarction.Circulation1994;90:753761.
- 7中华心血管病杂志编委会.急性心肌梗塞溶栓疗法参考方案.中华心血管病杂志1991;19:137.
- 8HarlanF ,etal.Cellularmechanismsofmyocardialinfarexpansion.Circulation1988;78:186201.
- 9WhiteHP ,NorrisRM ,BrownMA .Leftventricularendsystolicvolumeasthemajordeterminantofsurvivalafterrecoveryfrommyocardialinfarction.Circulation1987;76:44.
- 10BrodieBR ,StuckeyTD ,KisslingG ,etal.Improtanceofinfarct relatedarterypatencyforrecoveryofleftventricularfunctionandlatesurvivalafterprimaryangioplastyforacutemyocardialinfarction.JAmCollCardiol1996;28:319325.
- 11SheibanI,FragassoG ,LuC ,etal.Influeceoftreatmentdelayonlong leftventricularfunctioninpatientswithacutemyocardialinfarctionsuccessfullytreatedwithprimaryangioplasty.AmHeartJ 2001;141:603609.
- 12NicolasD ,MichaelA ,RomainC ,etal.Effectoflatepercutaneousangioplasticrecanalizationoftotalcoronaryarteryocclusiononleftventricularremodeling,ejectionfractionandregionalwallmotion.AmJCardiol1996;78:729735.
- 13MassroorG ,SamirP ,VirgijiaC ,etal.Serialchangesinleftventrcularfunctionaftercoronarybypass:implicationsinviabilityassessment.AmHeartJ 1995;129:2023.