摘要
[目的]采用心肌染色分级（MBG）方法及校正TIMI计帧（CTFC）方法评价急诊PCI术后心外膜血流正常患者的心肌微循环状态,探讨术后MBG分级及心功能的关系。[方法]选取35例首次急性前壁心肌梗死患者,发病12h内接受冠状动脉造影检查证实IRA为前降支的单支病变,并行急诊PCI治疗。术后IRA血流达TIMI 3级[校正TIMI计帧数（CTFC）〈40帧],管腔残余狭窄〈20%。术后重复造影测定CTFC值及MBG分级。血管成形术的成功标准为：IRA血管残余狭窄〈20%,前向血流TIMI 3级（校正TIMI计帧数CTFC〈40）。所有患者均给予冠心病二级预防治疗。根据PCI术后即刻造影MBG分级结果将患者分为两组,A组为心肌再灌注（MBG 0~1级）,B组为心肌再灌注（MBG 2~3级）。两组患者分别术后2~4周内行经胸超声心动图检查测定左室射血分数（LVEF）、局部室壁运动指数（RWMI）、左室收缩末期容积指数（LVEDVI）。[结果]两组患者住院期间无一例死亡,冠脉造影证实急诊PCI术后35例患者均获得TIMI3级血流（CTFC〈40）,其中12例出现心肌微循环无再灌注现象（MBG0~1级）,发生率34%。尽管术后前降支CTFC〈40帧,但两组患者平均TIMI帧数CTFC差异仍有显著性意义,A组平均CTFC（31.9±4.5）帧;B组平均CTFC（18.4±4.2）帧,P〈0.01。两组患者从发病到PCI时间B组明显短于A组,（9.6±2.3）h vs（6.1±3.0）h,P〈0.01。MBG水平与PCI术后心功能状态密切相关。住院期间A组患者的EF值明显低于B组,（45.1±5.1）%vs（58.0±8.0）%,P〈0.01。A组LVEDVI高于B组,而两组间RWMI差异亦有显著性意义（P〈0.01）。[结论]急诊PCI术后微循环灌注水平（MBG）与心功能改善密切相关。成功的急诊PCI术应为TIMI 3级血流,同时具有心肌微循环的良好灌注（MBG 2~3级）。早期急诊PCI对恢复和维持正常的微循环灌注至关重要。
[ Objectives] To investigate the relationship of myocardial blush grade （MBG） after PCI in patients with AMI and cardiac function. [ Methods] Thirty -five patients with a first anterior wall AMI who underwent PCI during 12 h, and TIMI 3 flow of IRA was enrolled in this study. TIMI 3 flow was defined by TIMI frame count （CTFC 〈40） through angiographic after PCI. IRAs were all LAD alone, the residual stenosis 〈 20%. All patients were used stent after balloon dilation. After stenting, CTFC and MBG can be measured by angiographic through the proper situation. According MBG, the patients were divided into two groups ： patients in group A were of no reflow （ MBG 0 - 1 ） and patients in group B were of reflow （ MBG 2 - 3 ）.LVEF, RWMI and LVEDVI were measured during 2 to 4 weeks after PCI. [ Results] Thirty - five patients were alive in hospital. The data from angiograph proved that IRAs all reached TIMI 3 grade （ CTFC 〈 40） after PCI. Of them, 12 patients （34%） were of no reflow. Although the CTFC in IRAs was less than 40, there was significant difference between the two groups （ P 〈 0.01 ）. The mean of CTFC in group A was 31.9± 4.5, while it was 18.4 ± 4.2 in group B. The time from chest pain onset to PCI in group B was shorter than that in group A significantly （9.6 ±2.3） h vs （6.1 ±3.0） h, P 〈0.05. The MBG was related to the cardiac function after PCI. LVEF in group A was lower than that in group A during hospitalization. （45.1 ± 5.1 ）% vs （58.0 ± 8.0）%, P 〈 0.01. LVEDVI in group A was higher than that in group B. RWMI also existed statistically difference between the both groups. [ Conclusion] The level of MBG after PCI is closely related to cardiac function in patients with acute myocardial infarction. Angiographic reperfusion is defined by TIMI 3 flow （CTFC 〈40） and MBG 2 or 3 after successful PCI in patients with AMI. Early PCI in patients with AMI is important to recovery and maintain microcirculatiory reperfusion.
出处
《大连医科大学学报》
CAS
2008年第3期227-231,共5页
Journal of Dalian Medical University
关键词
急性心肌梗死
冠脉造影
心肌染色分级
心脏功能
acute myacardid inforotion
angiography
myocardial blush grade
cardiac fanction
