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目的:探讨急性心肌梗死(AMI)患者直接及择期经皮冠状动脉介入治疗(PCI)对左心室重构和左心功能的影响。方法:对42例初次发病、发病时间在12h以内或12~24h之间的AMI患者,行直接PCI;对30例AMI患者行择期PCI。于术后2、15和30周行二维超声心动图检查并记录有关心脏事件。结果:术后2、15周直接PCI组的左心室收缩末容积指数(ESVI)、左心室舒张末容积指数(EDVI)、左心室射血分数(LVEF)和梗死区室壁运动指数(RWMI)均显著优于择期PCI组(P<0.05或P<0.01)。择期PCI组、直接PCI组15和30周ESVI、EDVI、LVEF及RWMI与2周时比均有显著改善(P<0.05,P<0.01)。至30周时,直接PCI组和择期PCI组EDVI、LVEF和RWMI差异无统计学意义,而ESVI差异有统计学意义(P<0.05)。全心室壁运动指数在2组间始终差异无统计学意义(P>0.05)。结论:直接PCI及择期PCI均可有效抑制左心室重构和改善左心室功能,但直接PCI更优于择期PCI。
Objective: To investigate the effect of direct and selective percutaneous coronary intervention (PCI) on left ventricular remodeling and left ventricular function in patients with acute myocardial infarction (AMI). Methods: Forty-two AMI patients with initial onset, onset time within 12 h or 12 to 24 h were enrolled in this study. PCI was performed in 30 AMI patients. Two-dimensional echocardiography was performed at 2, 15, and 30 weeks after surgery to record cardiac events. Results: The left ventricular end-systolic volume index (ESVI), left ventricular end-diastolic volume index (EDVI), left ventricular ejection fraction (LVEF) and infarct wall wall motion index (RWMI) Were significantly better than elective PCI group (P <0.05 or P <0.01). ESVI, EDVI, LVEF and RWMI at 15 and 30 weeks in elective PCI group and direct PCI group were significantly improved compared with those in 2 weeks (P <0.05, P <0.01). There was no significant difference in the EDVI, LVEF and RWMI between the direct PCI group and the elective PCI group by 30 weeks, but the difference of ESVI was statistically significant (P <0.05). There was no significant difference in total ventricular wall motion index between the two groups (P> 0.05). Conclusion: Both direct PCI and elective PCI can effectively suppress left ventricular remodeling and improve left ventricular function, but direct PCI is superior to elective PCI.