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目的 了解急性心肌梗死 (AMI)后侧支循环形成的情况及糖尿病对其影响。方法 采用 1 996年 1 2月～ 1 999年 1 2月阜外医院介入治疗中心收治的AMI后 3个月内冠状动脉造影显示梗死相关病变仍完全闭塞者共 2 1 0例作为研究对象。回顾性分析每例患者有无侧支循环形成、侧支循环形成的时间以及侧支循环与梗死相关病变部位、梗死前心绞痛和室壁瘤形成之间的关系 ,并比较合并(48例 )与不合并糖尿病 (1 62例 )患者侧支循环形成的不同。侧支循环的评价采用计分法。结果AMI后 2周内 42 8%的患者可见侧支循环 ,第 3周达 60 0 % ,1个月时高达 75 3 % ,说明AMI后 2周即有侧支循环的形成 ,多数形成于 3～ 4周。梗死后 1～ 3个月左室造影显示有室壁瘤形成的 1 1例非糖尿病AMI患者中只有 2例可见侧支循环 (1 8 2 % ) ,而无室壁瘤形成的 87例非糖尿病AMI患者中 83例可见侧支循环 (95 4% )。与非糖尿病患者相比 ,合并糖尿病的AMI患者梗死后第 4周方可见侧支循环。 48例糖尿病患者侧支循环计分平均 0 35 ,只有 9例可见侧支循环 (1 8 8% ) ;而 1 62例非糖尿病患者侧支循环计分平均 2 42 ,1 4 0例有侧支循环形成 (86 4% )。结论 AMI后如梗死相关病变仍完全闭塞 ,绝大多数于 3～ 4周形成侧支循环。室壁瘤患者很少形成侧
Objective To investigate the formation of collateral circulation after acute myocardial infarction (AMI) and the effect of diabetes on it. Methods A total of 210 cases of coronary artery infarction-related lesions were completely occluded within 3 months after AMI were treated in Fu Wai Hospital Interventional Therapy Center from January 1996 to January 1999. The relationship between the formation of collateral circulation, the formation time of collateral circulation, collateral circulation and infarction-related lesion, angina pectoris and aneurysm in each patient was retrospectively analyzed. Differences in the formation of collateral circulation in patients with diabetes mellitus (n = 162). Collateral circulation evaluation using scoring method. Results 42 8% of the patients within 2 weeks after AMI had collateral circulation, 60% of the patients in the third week and 75.3% of the patients in the first month after AMI. It showed that collateral circulation was formed in the second week after AMI, most of them formed in 3 ~ 4 weeks. Only 1 of 11 non-diabetic AMI patients with left ventricular angiography 1 to 3 months after infarction had left ventricular angiography showed only 2 collateral circulation (182%) without 87 aneurysms Eighty-three patients with AMI had collateral circulation (95.4%). Compared with non-diabetic patients, AMI patients with diabetes mellitus can see collateral circulation in the 4th week after infarction. 48 cases of diabetic patients collateral circulation scoring an average of 0 35, only 9 cases of collateral circulation (18.8%); and 162 non-diabetic collateral circulation scoring average 2 42,140 cases of collateral Circulation formation (86 4%). Conclusions After AMI, infarction-related lesions are still completely occluded, most of which form collateral circulation in 3 ~ 4 weeks. Patients with aneurysms rarely form sides