2018 年第 6 期 第 13 卷

急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后不同心肌灌注水平对心肌存活性的影响

Effect of myocardial perfusion on myocardial viability after percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

作者：张强刘珂牛红梅张巍马丽娟韩继如

英文作者：

单位：056002河北省邯郸市第一医院心内四科

英文单位：

关键词：急性ST段抬高型心肌梗死；经皮冠状动脉介入；心肌灌注水平；心肌存活性

英文关键词：

• 摘要：

• 【摘要】目的    分析急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后不同心肌灌注水平对心肌存活性的影响。方法    选取2016年3月至2017年3月于河北省邯郸市第一医院行PCI的63例急性STEMI患者作为研究对象，按照心肌梗死溶栓试验心肌灌注（TMP）分级分为A组（31例，TMP分级0～1级）和B组（32例，TMP分级2～3级）。观察2组患者PCI术后1周和12周的心肌灌注显像心肌缺损面积（MIA）和心肌存活情况，并比较2组冠状动脉病变部位及病变支数。结果    B组术后1周静态心肌显像、术后1周含服硝酸甘油心肌显像、术后12周静态心肌显像MIA百分比明显低于A组［（26±13）%比（39±16）%、（20±10）%比（34±11）%、（18±13）%比（37±10）%］，心肌存活性明显优于A组［（5.43±0.32）%比（4.12±0.15）%］，差异均有统计学意义（均P＜0.05）。B组单支病变、右冠状动脉病变比例明显高于A组［68.8%（22/32）比35.5%（11/31）、46.9%（15/32）比25.8%（8/31）］，多支病变、左前降支病变比例明显低于A组［9.4%（3/32）比29.0%（9/31）、25.0%（8/32）比51.6%（16/31）］，差异均有统计学意义（均P＜0.05）。结论    STEMI患者行PCI术后TMP分级2～3级可提高患者的心肌存活性，其心肌恢复较快。

• 【Abstract】Objective    To analyze the effect of myocardial perfusion on myocardial viability after percutaneous coronary intervention（PCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods    A total of 63 acute STEMI patients who had PCI from March 2016 to March 2017 in Handan First Hospital were divided into group A［thrombolysis in myocardial infarction myocardial perfusion（TMP） grade 0-1, n＝31］ and group B（TMP grade 2-3, n＝32）. Myocardial infarction area（MIA） and myocardial viability were assessed by myocardial perfusion imaging 1 and 12 weeks after PCI. Location and number of coronary artery disease were analyzed. Results    One-week MIA ratio assessed by resting myocardial perfusion imaging, 1-week MIA ratio assessed after taking nitroglycerin and 12-week MIA ratio assessed by resting myocardial perfusion imaging in group B were significantly lower than those in group A［（26±13）% vs（39±16）%, （20±10）% vs（34±11）%, （18±13）% vs（37±10）%］. Viable myocardium ratio in group B was significantly higher than that in group A［（5.43±0.32）% vs（4.12±0.15）%］（P＜0.05）. Single vessel disease ratio and right coronary artery disease ratio in group B were significantly higher than those in group A［68.8%（22/32） vs 35.5%（11/31）, 46.9%（15/32） vs 25.8%（8/31）］; multi-vessel disease ratio and left anterior descending branch disease ratio in group B were significantly lower than those in group A［9.4%（3/32） vs 29.0%（9/31）, 25.0%（8/32） vs 51.6%（16/31）］（P＜0.05）. Conclusions    TEMI patients with TMP grade 2-3 show good myocardial viability after PCI.