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目的探讨急诊和择期血运重建治疗对急性心肌梗死(AMI)患者心功能、心室重塑、神经内分泌活性的影响。方法对45例AMI患者分别予急诊血运重建治疗(n=20)和择期血运重建治疗(n=25);分别检测AMI后1周和6个月的左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)和血清去甲肾上腺素(NE)、肾素活性(RA)、血管紧张肽Ⅱ(AngⅡ)及醛固酮(ALD)的含量。结果与择期血运重建组同时点亚组比较,急诊血运重建组各亚组的NE均显著降低(P<0.05);急诊血运重建组6个月亚组的NE、择期血运重建组6个月亚组的NE和RA均显著低于相应同组1周亚组(P<0.05);两组的AngⅡ、ALD、LVEDD、LVEF和VE/VA于组间和组内比较,差异无统计学意义(P>0.05)。结论急诊血运重建抑制AMI后交感神经系统过度激活的作用强于择期血运重建,但在进一步抑制肾素-血管紧张肽-醛固酮系统、心室重塑,改善心脏收缩和舒张功能方面并不具备更大的优势。
Objective To investigate the effects of emergency and elective revascularization on cardiac function, ventricular remodeling and neuroendocrine activity in patients with acute myocardial infarction (AMI). Methods 45 cases of AMI were treated by emergency revascularization (n = 20) and elective revascularization (n = 25) respectively. Left ventricular end-diastolic dimension (LVEDD) at 1 week and 6 months after AMI were measured, Left ventricular ejection fraction (LVEF) and ratio of early diastolic flow velocity to atrial systolic velocity (VE / VA), serum norepinephrine (NE), renin activity (Ang Ⅱ) and aldosterone (ALD) content. Results Compared with the elective revascularization group at the same time point, the NE of EMT subgroups in emergency revascularization group was significantly decreased (P <0.05); NE, elective revascularization group at 6 months in emergency revascularization group The NE and RA of the 6-month subgroup were significantly lower than those of the corresponding 1-week subgroup (P <0.05). There was no significant difference between the two groups in the levels of AngⅡ, ALD, LVEDD, LVEF and VE / VA Statistical significance (P> 0.05). Conclusions Emergency revascularization suppresses the over-activation of sympathetic nervous system after acute myocardial infarction. It is better than elective revascularization, but it is not available in further inhibiting renin-angiotensin-aldosterone system, ventricular remodeling, improving cardiac contractility and diastolic function Greater advantage.