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目的观察急性下壁心肌梗死患者右心功能动态变化及急诊经皮腔内冠状动脉介入治疗成形术(percuta-neous coronary intervention,PCI)治疗对其影响。方法急性下壁心梗患者42例,27例于起病12h内接受PCI治疗(急诊PCI组),余者接受择期PCI治疗(择期PCI组)。分别于心梗后1、3、7、15、30d行超声心动图检查,组织多普勒测量右房室环收缩期峰值运动速度(Sm)和舒张早期峰值运动速度/心房收缩期峰值运动速度(Em/Am)比值评估右心室收缩和舒张功能。结果右室收缩功能心梗后1d最差,舒张功能心梗后3d最差,之后逐渐恢复,观察期结束时(第30天)最佳。急诊PCI组Sm最小值和最大值,以及Em/Am比值最大值皆高于择期PCI组(P<0.01,P<0.05)。Sm值急诊PCI组在第7天即显著增高,择期PCI组第15天显著增高(P<0.05);Em/Am值急诊PCI组在第15天显著增高,择期PCI组第30天方显著增高(P<0.05)。结论急性下壁心梗损害右室收缩和舒张功能以心梗3d内最为严重,急诊PCI较择期PCI治疗更利于其恢复。
Objective To observe the dynamic changes of right heart function in patients with acute inferior myocardial infarction and the effects of percutaneous coronary interventional angioplasty (PCI). Methods Forty-two patients with acute inferior myocardial infarction were enrolled. Twenty-seven patients were treated with PCI within 12 hours of onset (emergency PCI group) and the remaining patients were treated with elective PCI (elective PCI group). Echocardiography was performed on the 1st, 3rd, 7th, 15th and 30th days after myocardial infarction respectively. The systolic peak velocity (Sm) (Em / Am) ratio to assess right ventricular systolic and diastolic function. Results Right ventricular systolic function myocardial infarction 1d worst, diastolic myocardial infarction 3d worst, and then gradually recovered, the end of the observation period (30 days) the best. The minimum and maximum values of Sm and the maximum values of Em / Am in emergency PCI group were higher than those in elective PCI group (P <0.01, P <0.05). The value of Sm in PCI group was significantly higher on the 7th day, significantly higher on the elective PCI group on the 15th day (P <0.05); Em / Am value of the emergency PCI group was significantly increased on the 15th day, P <0.05). Conclusions Acute inferior myocardial infarction damages right ventricular systolic and diastolic function is most serious in myocardial infarction in 3d, emergency PCI is more conducive to the recovery of PCI than elective PCI.