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目的利用经冠状动脉超声心肌声学造影(MCE)比较单支血管不同程度狭窄病变冠心病患者经皮冠状动脉介入术(PCI)后心肌灌注的变化,并探讨其临床意义。方法62例进行PCI治疗的住院患者根据选择性冠状动脉造影结果,按血管狭窄程度分组:A组,血管狭窄75%~95%;B组,血管狭窄>95%;C组,急性血管闭塞。PCI前及术后15 min进行经冠状动脉MCE,检测心肌灌注状况。其中,MCE有关定量参数分别为:造影剂峰值密度反映心肌血容量;峰值时间反映心肌灌注速度;曲线下面积反映心肌血流量。结果所有患者PC I后均达到TIMIⅢ级血流;A组术后心肌血流量较术前增加(P<0.05);B组心肌血容量及血流量也较术前增加(P<0.05);而C组心肌血容量、血流量及灌注速度较术前增加更显著(P<0.01)。结论不同狭窄程度病变冠心病患者,PCI后心肌灌注均得到不同程度改善,其中,以急性闭塞病变改善最明显,该类患者为PCI治疗的最大获益者。
Objective To compare the changes of myocardial perfusion after percutaneous coronary intervention (PCI) in patients with coronary artery disease and coronary artery stenosis with different degrees of stenosis by means of coronary artery sonic myocardial contrast echocardiography (MCE), and to explore its clinical significance. Methods Sixty-two inpatients undergoing PCI were divided into two groups according to the results of selective coronary angiography: group A with 75% -95% of vessel stenosis; group B with vessel stenosis> 95%; group C with acute vessel occlusion. PCI and 15 min after surgery through the coronary artery MCE, myocardial perfusion detection. Among them, the quantitative parameters of MCE are as follows: the peak density of contrast medium reflects the myocardial blood volume; the peak time reflects the myocardial perfusion rate; and the area under the curve reflects the myocardial blood flow. Results All patients achieved TIMI grade Ⅲ blood flow after PC Ⅰ. A group of postoperative myocardial blood flow increased compared with preoperative (P <0.05); B group myocardial blood volume and blood flow also increased compared with preoperative (P <0.05); Myocardial blood volume, blood flow and perfusion rate in group C were more significant than those before operation (P <0.01). Conclusions Patients with coronary artery disease with different degree of stenosis and myocardial perfusion after PCI have all improved in varying degrees. Among them, the most obvious improvement is in patients with acute occlusion, and these patients are the most beneficiaries of PCI.