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目的 :探讨左室造影对急性心肌梗死 (AMI)后左室重构发生的评价及其临床意义。方法 :用左室造影投影系统计算出心肌梗死 (MI)急性期及恢复期左室容积指标 ,根据左室容积指标将患者分为重构组和非重构组 (均为 2 0例 ) ;用漂浮导管测定血流动力学指标 ;用99m 锝心血池扫描测定左室射血分数 (LVEF) ;用2 0 1铊心肌血流扫描测定梗死的面积积分 (ES)和重症度积分(SS)。结果 :重构组恢复期左室舒张末期及收缩末期容积均显著高于非重构组 (P <0 .0 1) ,亦显著高于该组急性期左室容积 (P <0 .0 1)。重构组急性期肌酸磷酸激酶峰值、急性期及恢复期肺小动脉嵌压、恢复期左室舒张末压力以及恢复期ES和SS均显著高于非重构组 ,而LVEF显著低于非重构组。重构组恢复期左室收缩末期容积及舒张末期容积与LVEF之间存在有意义的相关关系 (r =- 0 .72 ,P <0 .0 1;r =- 0 .6 7,P <0 .0 1)。结论 :AMI后进行左室造影能较准确地评价左室重构的发生及严重程度。发生左室重构的患者其心肌坏死量较大 ,且其恢复期左室功能显著降低。恢复期左室功能与左室容积指标之间存在密切相关。
Objective: To evaluate left ventricular remodeling after acute myocardial infarction (AMI) and its clinical significance. Methods: Left ventricular volume index was calculated at acute and convalescent stage of myocardial infarction (MI) by left ventricular imaging system. The patients were divided into reconstructed group and non - reconstructed group according to left ventricular volume (all 20 cases). The indexes of hemodynamics were measured with floating catheter. Left ventricular ejection fraction (LVEF) was measured by 99mTc-flow cytometry. Infarct area score (ES) and severity score (SS) . Results: The volumes of left ventricular end-diastolic and end-systolic phases in convalescent group were significantly higher than that in non-reconstructed group (P <0.01), and also significantly higher than that in acute group (P <0.01) ). In the reconstructed group, peak values of creatine phosphokinase in acute phase, pulmonary arteriolar pressure in acute phase and convalescent phase, left ventricular end-diastolic pressure in convalescent phase and convalescent ES and SS in acute phase were significantly higher than those in non-reconstructed group, while LVEF was significantly lower than non-reconstructed group Reconstruction group. There was a significant correlation between LV end-systolic volume and end-diastolic volume and LVEF in remodeling group (r = - 0.72, P <0.01; r = - 0.67, P <0 .0 1). Conclusion: Left ventricular angiography after AMI can accurately evaluate the occurrence and severity of left ventricular remodeling. In patients with left ventricular remodeling myocardial necrosis larger, and its convalescent LV function was significantly reduced. Convalescent left ventricular function and left ventricular volume indicators are closely related.