ST段抬高型心肌梗死冠状动脉侧支循环形成良好与不良患者微循环阻力指数和心功能的比较被引量：9

Comparisons of index of microcirculatory resistance and heart function of good and bad coronary collateral circulation in ST segment elevation myocardial infarction

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摘要目的比较ST段抬高型心肌梗死患者冠状动脉侧支循环形成良好和不良的微循环阻力指数（index of microcirculatory resistance,IMR）以及心功能指标。方法选择2012年1月~2014年3月在青岛市市立医院心内科住院的ST段抬高型心肌梗死错过血运重建时间（〉12 h）,15 d后行冠状动脉造影及经皮冠状动脉介入治疗（PCI）的患者34例,其中男性28例,女性6例,年龄31~82岁（63.0±12.4）岁。按照Rentrop分级将所有患者分为侧支循环形成良好组（A组,Rentrop：2~3级,n=19）和侧支循环形成不良组（B组,Rentrop：0~1级,n=15）。所有入选者均行冠状动脉造影和置入支架,后测定IMR,于术前及术后3个月测定左室舒张末期内径（LVEDD）、左室射血分数（LVEF）。结果两组患者年龄、性别比例、高血压、糖尿病和陈旧性心肌梗死比较,差异无统计学意义（P均〉0.05）。与B组比较,A组IMR降低,（32.0±7.6）vs.（21.2±4.5）,差异有统计学意义（P〈0.01）。A组PCI术后3个月较术前LVEF增加,差异有统计学意义（P〈0.05）。B组PCI术后3个月较术前LVEDD增加,差异有统计学意义（P〈0.05）。与A组比较,B组PCI术后3个月LVEDD[（47.4±2.4）mm vs.（53.6±5.0）mm]增加,LVEF[（56.5±3.3）%vs.（46.1±8.8）%]下降,差异有统计学意义（P〈0.05）。所有患者的冠状动脉侧支分级与IMR呈负相关（r=-0.601,P〈0.001）;IMR与PCI术后3个月的LVEDD呈正相关（r=0.842,P〈0.01）,与PCI术后3个月的LVEF呈负相关（r=-0.830,P〈0.01）。结论 ST段抬高型心肌梗死冠状动脉侧支循环形成不良患者较良好患者更易出现微循环功能障碍,PCI后心功能更差。 Objectives Comparisons of index of microcirculatory resistance and heart function of good and bad coronary collateral circulation in ST elevation myocardial infarction. Methods In Qingdao Municipal Hospital, 34 inpatients with ST segment elevation myocardial infarction（STEMI） from January 2012 to March 2014 were selected. These patients missed blood supply reconstruction（〉12h）, and then were performed coronary angiography and PCI after 15 days. The patients including 28 males and 6 females, from 31 to 82 years old（63.0±12.4 years old）. According to the Rentrop grade, these patients were divided into 2 groups： collateral circulation formation group（group A, Rentrop=2-3, n=19） and collateral circulation formation adverse group（group B, Rentrop=0-1, n=15）. The index of microcirculatory resistance（IMR） was measured after all patients underwent coronary angiography and stent implantation. Left ventricular end diastolic diameter（LVEDD） and left ventricular ejection fraction（LVEF） were measured before and in 3 months after procedure. Results No statistically significant difference was shown in age, gender, hypertension, diabetes mellitus and chronic myocardial infarction in two groups（P〈0. 05）. Compared with B group, IMR [（32 ＋ 7.6） vs.（21.2 ＋ 4.5）] was significantly decreased in A group（P0.01）. The LVEF of A group was significantly increased after procedure（P〈0. 05）. LVEDD in B group was significantly increased after 3 months（P〈0. 05）. Compared with A group, LVEDD was significantly increased [（47.4 ＋ 2.4 mm vs.（53.6 ＋ 5.0） mm], and LVEF was significantly decreased [（56.5 ＋ 3.3） % vs.（46.1 ＋ 8.8） %] in B group after PCI（P〈0. 05）. The coronary collateral grading in all patients was negatively correlated with IMR（r=-0.601, P〈0.001）; IMR was positively correlated with LVEDD in 3 months after PCI（r=0.842, P〈0.01）; and IMR was negatively correlated with LVEF in 3 months after PCI（r=-0.830, P〈0.01）. Conclusion STEMI patients in poor coronary collateral circulation are more prone to microcirculatory dysfunction and worse heart function after PCI.

作者王世超张纯全刘玉昊武越邵一兵许文亮王旭

机构地区青岛大学医学院附属青岛市市立医院东院心内科

出处《中国循证心血管医学杂志》 2016年第2期183-185,共3页 Chinese Journal of Evidence-Based Cardiovascular Medicine

关键词微循环阻力指数(IMR) 侧支循环 PCI 心功能 Index of microcirculatory resistance（IMR） Collateral circulation PCI Cardiac function

分类号 R331.35 [医药卫生—人体生理学]

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