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目的 比较直接经皮冠状动脉腔内成形术 (PTCA)与溶栓治疗对急性心肌梗死 (AMI)患者梗死面积和左心室功能的影响。方法 对 47例AMI患者经PTCA术和静脉溶栓治疗患者行硝酸异山梨醇酯99mTc MIBI心肌断层显像定量分析 ,测定心肌梗死的面积 ;急性心肌梗死后 10～ 14天行超声心动图检查测定左心室射血分数。结果 直接PTCA术患者心肌梗死面积绝对值和梗死面积占左心室的百分数均小于溶栓再灌注组 [分别为 (10 5± 12 5 )cm2 vs(49 0± 2 8 3)cm2 ,P <0 0 5 ;(9 1±13 6 ) %vs(2 6 6± 15 5 ) % ,P <0 0 5 ],溶栓再灌注组则小于溶栓未再灌注组 [分别为 (49 0± 8 3)cm2vs(95 7± 5 9 3)cm2 ,P <0 0 5 ;(2 6 6± 15 5 ) %vs(5 1 9± 2 1 1) % ,P <0 0 1) ]。直接PTCA组左心室射血分数高于溶栓再灌注组 [(6 4 2± 8 3) %vs(5 4 3± 12 5 ) % ,P <0 0 5 ],而溶栓再灌注组高于未再灌注组 [(5 4 3± 12 5 ) %vs(43 2± 7 0 ) % ,P <0 0 1]。结论 AMI直接PTCA术与静脉溶栓治疗比较 ,能最大限度缩小梗死面积 ,更好地保护心功能。
Objective To compare the effects of direct percutaneous transluminal coronary angioplasty (PTCA) and thrombolytic therapy on infarct size and left ventricular function in patients with acute myocardial infarction (AMI). Methods Forty-seven patients with acute myocardial infarction (AMI) undergoing PTCA and intravenous thrombolysis were subjected to isomycinol 99mTc MIBI myocardial perfusion quantitative analysis to determine the area of myocardial infarction. The myocardial infarction size was measured 10 to 14 days after acute myocardial infarction by echocardiography Left ventricular ejection fraction. Results The absolute value of myocardial infarction area and the percentage of infarction area in left ventricle of PTCA patients were less than that of thrombolytic and reperfusion groups [(105 ± 125) cm2 vs (49 0 ± 2 8 3) cm2, P <0 (9 1 ± 13 6)% vs (26 6 ± 15 5)%, P 0 05, respectively. The volume of thrombolysis-reperfusion group was smaller than that of the group without thrombolysis 3) cm2vs (957 ± 5 9 3) cm2, P <0 05; (26 6 ± 15 5)% vs (51 9 ± 2 1 1)%, P 0 01). The left ventricular ejection fraction in the direct PTCA group was higher than that in the thrombolysis-reperfusion group [(62.4 ± 8.3)% vs (54.3 ± 125)%, P <0.05) Reperfusion group [(543 ± 125)% vs (432 ± 70)%, P <0.01]. Conclusion AMI direct PTCA compared with intravenous thrombolysis, can minimize infarct size, better protection of cardiac function.