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目的 探讨急症经皮冠脉介入 (PCI)冠脉无复流患者左室功能的临床意义。方法 自1999年 1月至 2 0 0 2年 10月 ,回顾性分析北京朝阳医院心脏中心 4 97例急诊PCI患者的临床和影像资料。急诊PCI即刻 ,在无影响血流的血栓、栓塞、夹层动脉瘤、痉挛情况下 ,冠脉造影前向血流≤TIMI 2级为无复流 ,TIMI 3级为正常血流。冠脉无复流患者 5 8例 ,利用Excel随机函数表 ,由其余 4 39例急诊PCI冠脉前向血流恢复正常的患者中随机抽取 6 0例 ,为正常血流组。结果 无复流和正常血流患者的酶峰值、Killip心功能分级、Q波计数、WMS有显著性差异 (P <0 .0 5 )。正常血流患者术后 2周WMS改善 ,LVEF ,CI,SVI增加 (P <0 .0 5 )。正常血流合并心功能不全的患者术后 2周LVEF ,CI,SVI增加 (P<0 .0 5 ) ,LVEDV、LVESV (P <0 .0 1)减少 ;而无复流合并心功能不全的患者LVEDV、LVESV增加 (P<0 .0 1)。结论 无复流患者的心肌损害严重 ,梗死或濒临坏死的心肌范围广泛 ;室壁运动恢复较慢和局部心肌功能不良 ;左室舒缩功能降低
Objective To investigate the clinical significance of left ventricular function in emergency percutaneous coronary intervention (PCI) patients with no-reflow coronary artery disease. Methods From January 1999 to October 2002, the clinical and imaging data of 4 97 emergency PCI patients in Beijing Chaoyang Hospital Cardiac Center were retrospectively analyzed. Emergency PCI immediately, without affecting the blood flow of thrombus, embolism, dissecting aneurysm, spasticity, coronary angiography before the blood flow ≤ TIMI level 2 no-reflow, TIMI level 3 for the normal blood flow. Fifty-eight patients with coronary artery no-reflow were randomized to 60 normal subjects with normal blood flow by using the Excel function table. Results There were significant differences in peak of enzyme, Killip heart function grading, Q wave count and WMS in patients with no-reflow and normal blood flow (P <0.05). WMS improved, LVEF, CI, SVI increased 2 weeks after operation in normal blood flow patients (P <0.05). LVEF, CI, SVI increased (P <0.05), LVEDV, LVESV (P <0. 01) decreased in patients with normal blood flow and cardiac insufficiency at 2 weeks after operation, while those with no-reflow combined with cardiac insufficiency Patients LVEDV, LVESV increased (P <0.01). Conclusions Myocardial injury is serious in patients with no-reflow disease, with a wide range of myocardial infarction or near necrosis; slow recovery of ventricular wall motion and local myocardial dysfunction; decreased left ventricular systolic and diastolic function