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目的 :探讨经皮冠状动脉介入治疗对急性前壁心肌梗死患者左心室功能的影响 ,以指导对其合理的治疗。方法 :选择首次Q波急性心肌梗死 (AMI)的患者 5 3例 ,随机分为介入治疗组 (A组 )和药物治疗组 (B组 ) ,A组病人于AMI后 2～ 4周行冠脉造影并证实存在梗塞相关血管 (IRA)而行经皮冠状动脉腔内成形术 (PTCA)及支架植入术 ,其他治疗同B组。常规检查血压、血糖、血脂、心肌酶谱、心电图及超声心动图等 ,并于半年后复查 ,随访半年内心脏事件发生情况。超声心动图主要观察室壁运动指数 (WMI)、左室射血分数 (LVEF)、左室中部的最大收缩期流速 (Vp)及二尖瓣舒张晚期与早期峰值流速之比值 (A/E)。结果 :A组的 3 2例病人PTCA及支架植入均获成功 ,且达 3级TIMI血流。半年后 ,A、B组各失访 2例 ,剩余病人中 ,A组 (3 0人 )和B组 (19人 )随访前后在心率、血压、血糖及血脂方面无明显差异 (P >0 .0 5 )。与梗塞后 2～ 4周比较 ,B组Vp、A/E、WMI及LVEF无改善(P >0 .0 5 ) ,而A组Vp、A/E及WMI均有显著改善 (P<0 .0 5 ) ;半年后 ,B组病人再梗塞、室壁瘤形成及心功能(NYHA)ⅢⅣ级者均高于A组 (P <0 .0 5及P <0 .0 1) ;A组与B组比较 ,Vp、A/E、WMI及LVEF均存在明显差异 (P <0 .0 5及P <0 .0 1) ,但两组不稳定型心绞痛发生率?
Objective: To investigate the effect of percutaneous coronary intervention on left ventricular function in patients with acute anterior myocardial infarction to guide its rational treatment. Methods: Fifty-three patients with AMI were randomly divided into intervention group (A group) and drug treatment group (B group). Patients in group A underwent coronary angiography 2 to 4 weeks after AMI Confirmed the existence of infarct-related vessels (IRA) underwent percutaneous transluminal coronary angioplasty (PTCA) and stent implantation, the other treatment with the B group. Routine examination of blood pressure, blood glucose, lipids, myocardial enzymes, electrocardiogram and echocardiography, etc., and in six months after the review, follow-up within six months of cardiac events. Echocardiography was performed to observe the changes of wall motion index (WMI), left ventricular ejection fraction (LVEF), maximal systolic velocity (Vp) and mitral diastolic velocity (A / E) . Results: In group A, 32 patients were successfully treated with PTCA and stent implantation, and achieved grade 3 TIMI flow. Six months later, there were 2 cases lost in group A and B, and the remaining patients had no significant difference in heart rate, blood pressure, blood glucose and blood lipid before and after follow-up in group A (30) and group B (19) (P> 0.05). 0 5). Compared with 2 to 4 weeks after infarction, Vp, A / E, WMI and LVEF in group B were not improved (P> 0.05), but Vp, A / E and WMI in group A were significantly improved (P < After 6 months, the patients with re-infarction, aneurysm formation and NYHA Ⅲ Ⅳ in group B were higher than those in group A (P0.05 and P0.01) There were significant differences in Vp, A / E, WMI and LVEF in group B (P <0.05 and P <0.01), but the incidence of unstable angina in both groups was significantly higher