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目的对接受不同介入治疗(PC I)方案患者心功能及心肌组织血流灌注的研究,探讨急性心肌梗死(AM I)患者行PC I最佳时机和方法。方法入选69例行介入治疗AM I患者,分为直接PC I组(A组)、易化联合PC I组(B组)、延迟PC I组(C组)三组。术后第7、30天行心脏超声及99mTc-甲氧基异丁基异腈(M IB I)心肌灌注断层显像(SPECT),评价心功能及心肌组织灌注。结果①三组患者扩张后即刻造影结果显示,管腔残余狭窄率<10%,手术成功率100%。②第30天时A、B两组左心室收缩、舒张末容积指数(LVESVI、LVEDVI)、左心室射血分数(LVEF)均优于C组。③第30天时放射性缺损面积(M IA)A、B两组低于C组,A、B两组心肌组织血流灌注均优于C组。④住院期间A组1例患者发生急性血栓形成,三组患者无死亡病例,随访期间C组1例患者死于心功能衰竭。结论直接PC I、易化PC I可显著提高AM I患者的近期心肌组织血流灌注,缩小心肌梗死面积,保护心功能;延迟PC I宜早期进行。
Objective To investigate the cardiac function and myocardial perfusion in patients undergoing interventional therapy (PC I) and to explore the optimal timing and method of PC I in patients with acute myocardial infarction (AMI). Methods Sixty-nine patients with AMI were enrolled in this study. Patients were divided into direct PC I group (group A), facilitation combination PC I group (group B), and delayed PC I group (group C). Cardiac function and myocardial perfusion were evaluated by echocardiography and 99mTc-MIBI myocardial perfusion imaging (SPECT) on the 7th and 30th postoperative days. Results ① Immediately after the expansion of the three groups, the radiographic results showed that the residual stenosis rate was less than 10% and the successful rate was 100%. ② On day 30, the left ventricular systolic and diastolic volume index (LVESVI, LVEDVI) and left ventricular ejection fraction (LVEF) of group A and group B were better than those of group C. ③ On the 30th day, the area of radioactive defect (M IA) in group A and B was lower than group C, and the perfusion of myocardium in group A and group B was better than group C. ④ During hospitalization, one patient in group A developed acute thrombosis and none died in three groups. One patient in group C died of heart failure during follow-up. Conclusions Direct PC I and easy PC I can significantly improve myocardial perfusion, shorten the area of myocardial infarction and protect cardiac function in patients with AMI. The delayed PC I should be performed early.