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目的:比较急性Q波性心肌梗死(QMI)和非Q波性心肌梗死(NQMI)患者临床和冠状动脉病变特征以及梗死相关区域存活心肌的情况,并随访观察其对心肌梗死晚期血运重建术后心功能的影响。方法:连续收集121例急性心肌梗死(AMI)患者,分为QMI组(79例)和NQMI组(42例)。详细记录和分析所有患者的病史资料。于AMI后2周左右行经皮冠状动脉介入治疗,术前采用小剂量多巴酚丁胺超声负荷试验,检查梗死相关区域存活心肌的情况,并且于术前和术后6个月时常规超声心动图检查左室功能和室壁节段性运动障碍情况。随访6个月内主要心血管事件的发生率。结果:AMI前有心绞痛发作史者和冠状动脉病变血管的数量在NQMI组明显多于QMI组(P<0.05),而梗死相关部位平均管腔残余狭窄以NQMI组明显小于QMI组(P<0.05)。NQMI组中86%的患者有存活心肌,明显高于QMI组(61%)(P<0.01)。术后6个月随访,2组左室射血分数较术前明显提高,左室舒张末期及收缩末期容积指数、室壁运动积分均较术前明显降低(分别为P<0.05和P<0.01),以NQMI组更明显。结论:与QMI相比,NQMI患者有较多的存活心肌;心肌梗死后晚期血运重建能更有利于改善NQMI患者远期左室功能。
OBJECTIVE: To compare the clinical features of coronary artery disease with the survival myocardial infarction-related areas in patients with acute Q-wave myocardial infarction (QMI) and non-Q-wave myocardial infarction (NQMI) and to investigate the effect of late myocardial revascularization After heart function impact. Methods: A total of 121 acute myocardial infarction (AMI) patients were randomly divided into QMI group (79 cases) and NQMI group (42 cases). Detailed documentation and analysis of all patient history data. Percutaneous coronary intervention was performed at about 2 weeks after AMI. Preoperative low-dose dobutamine stress test was used to check the survival of myocardial infarction-related areas. Conventional echocardiography was performed preoperatively and 6 months after surgery Figure check left ventricular function and ventricular segmental dyskinesia. The incidence of major cardiovascular events within 6 months of follow-up. Results: The number of patients with angina pectoris before onset of AMI and those with coronary artery lesions were significantly more in NQMI group than in QMI group (P <0.05), while the mean residual cavity stenosis in infarct - related sites was significantly smaller in NQMI group than in QMI group (P <0.05) ). Eighty-six percent of patients in the NQMI group had viable myocardium, significantly higher than those in the QMI group (61%) (P <0.01). After 6 months of follow-up, the left ventricular ejection fraction (LVEF) of the two groups was significantly higher than that before the operation, the left ventricular end-diastolic and end-systolic volume indices and ventricular wall motion scores were significantly lower than those before operation (P <0.05 and P <0.01 ), More obvious in the NQMI group. Conclusion: Compared with QMI, NQMI patients have more viable myocardium; late revascularization after myocardial infarction can be more beneficial to improve long-term left ventricular function in patients with NQMI.