AMI患者PCI术后校正TIMI帧数与梗死区域心肌组织收缩功能的影响
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摘要
目的分析急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)术后校正TIMI帧数对梗死区域心肌组织收缩功能的影响。方法选择该院84例行PCI治疗的AMI患者作为研究对象,采用斑点追踪技术对术后患者梗死相关动脉的校正TIMI帧数进行测定,记录慢血流与快血流的例数,对患者肌酸激酶同工酶(CK-MB)及左心室射血分数(LVEF)的水平进行检测,同时对患者梗死区域的纵向应变(LS)与径向应变(RS)的水平进行测定。结果 84例患者慢血流者37例为S组,快血流者47例为F组。其中,S组校正TIMI帧数显著高于F组(P<0.01);两组术后12h时CK-MB水平的比较,差异无统计学意义(P>0.05);两组术后1d时的水平较术后12h均显著升高(P<0.01),并且S组的水平明显高于F组(P<0.01)。两组术后4周LVEF的水平较术前7d均显著升高,但两组术后7d、4周LVEF水平的比较,差异无统计学意义(P>0.05)。两组术后7d、4周LS水平的比较,差异无统计学意义(P>0.05);并且两组术后4周与术后7d时LS水平的比较,差异无统计学意义(P>0.05)。两组术后7d时RS水平的比较,差异无统计学意义(P>0.05);术后4周时F组RS水平明显高于S组(P<0.01),但两组术后4周与术后7d时的比较,差异无统计学意义(P>0.05)。结论 AMI患者行PCI术后校正TIMI帧数与梗死区域心肌局部收缩功能存在一定的联系,校正TIMI帧数可作为评估AMI患者PCI术后疗效的预测指标。
Objective To analyze the corrected TIMI frame count and myocardial infarction area systolic function on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 84 patients with AMI treated by PCI were selected as the research objects in our hospital.The postoperative corrected TIMI frame count of infarct related artery were measured,the numbers of slow flow and fast flow were recorded,and the levels of creatine kinase isoenzyme(CK-MB)and left ventricular ejection fraction(LVEF)were detected.The longitudinal strain(LS)and radial strain(RS)levels were measured.Results Among of the 84 patients,there were 37 cases of slow flow as the group S,47 cases of fast flow as the group F.The corrected TIMI frame count in the group S was significantly higher than that of the group F(P<0.01).After 12 hof surgery,the CK-MB levels of the two groups showed no significant difference(P>0.05).After one day of operation,the levels of the two group were significantly increased(P<0.01),and the level in the group S was significantly higher than that of the group F(P<0.01).The levels of LVEF in the two groups after 4 weeks were significantly higher than that of the preoperative 7 days,but the levels at 4 weeks after operation showed no significant difference in comparison of the levels at the 7 days after operation between the two groups(P>0.05).There was no significant difference in the LS levels between the two groups after operation for 7 days and 4 weeks(P>0.05),and the levels at 4 weeks after operation showed no significant difference in comparison of the levels at the 7 days after operation of the two groups(P>0.05).The RS levels showed no significant difference between the two groups after 7 days of operation(P>0.05).After 4 weeks,the RS level of the group F was significantly higher than that of the group S(P<0.01),but compared with the levels for 7 days after operation,the levels of two groups after 4 weeks showed no significant difference(P>0.05).Conclusion The corrected TIMI frame count is related to the systolic function of myocardial infarction area in patients with AMI after PCI,so it can be used as a predictor of the efficacy in patients with of AMI after PCI.
Objective To analyze the corrected TIMI frame count and myocardial infarction area systolic function on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 84 patients with AMI treated by PCI were selected as the research objects in our hospital.The postoperative corrected TIMI frame count of infarct related artery were measured,the numbers of slow flow and fast flow were recorded,and the levels of creatine kinase isoenzyme(CK-MB)and left ventricular ejection fraction(LVEF)were detected.The longitudinal strain(LS)and radial strain(RS)levels were measured.Results Among of the 84 patients,there were 37 cases of slow flow as the group S,47 cases of fast flow as the group F.The corrected TIMI frame count in the group S was significantly higher than that of the group F(P<0.01).After 12 hof surgery,the CK-MB levels of the two groups showed no significant difference(P>0.05).After one day of operation,the levels of the two group were significantly increased(P<0.01),and the level in the group S was significantly higher than that of the group F(P<0.01).The levels of LVEF in the two groups after 4 weeks were significantly higher than that of the preoperative 7 days,but the levels at 4 weeks after operation showed no significant difference in comparison of the levels at the 7 days after operation between the two groups(P>0.05).There was no significant difference in the LS levels between the two groups after operation for 7 days and 4 weeks(P>0.05),and the levels at 4 weeks after operation showed no significant difference in comparison of the levels at the 7 days after operation of the two groups(P>0.05).The RS levels showed no significant difference between the two groups after 7 days of operation(P>0.05).After 4 weeks,the RS level of the group F was significantly higher than that of the group S(P<0.01),but compared with the levels for 7 days after operation,the levels of two groups after 4 weeks showed no significant difference(P>0.05).Conclusion The corrected TIMI frame count is related to the systolic function of myocardial infarction area in patients with AMI after PCI,so it can be used as a predictor of the efficacy in patients with of AMI after PCI.
引文
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[14]GULEL O,AKCAY M,SOYLU K,et al.Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon:A Study of Speckle Tracking Echocardiography[J].Echocardiog,2016,33(5):714-723.
[15]AGHAJANI H,FAAL M,HOSSEINSABET A,et al.Evaluation of left atrial function via two-dimensional speckle-tracking echocardiography in patients with coronary artery ectasia[J].J Clin Ultrasound,2017,45(4):231-237.
[2]张雁,吴弘,孙育民,等.自制给药系统冠状动脉内注射替罗非班对急性心肌梗死再灌注疗效的影响[J].国际心血管病杂志,2017,44(3):185-188.
[3]CARRICK D,OLDROYD K G,MCENTEGART M,et al.A randomized trial of deferred stenting versus immediate stenting to prevent no-or slow-reflow in acute ST-segment elevation myocardial infarction(DEFER-STEMI)[J].South China J Cardiol,2014,63(1):2088-2098.
[4]刘净敏,耿巍,田祥,等.经球囊导管冠状动脉内注射尿激酶原对急性STEMI患者心肌灌注的疗效[J].临床荟萃,2016,31(11):1192-1196.
[5]LIGA R,ORSINI E,CARAVELLI P,et al.Interactions Between Reciprocal ST-Segment Downsloping During STElevated Myocardial Infarction and Global Cardiac Perfusion and Functional Abnormalities[J].Am J Cardiol,2017,119(12):1902-1908.
[6]赵蓓,刘利峰,刘瑛琪,等.冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死患者心肌灌注及短期预后的影响[J].解放军医学杂志,2015,40(8):661-665.
[7]WANG Y,MA C,ZHANG Y,et al.Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon[J].PLoS One,2015,10(2):e0117979.
[8]周骏,朱海,秦忠,等.替罗非班在老年糖尿病合并AMI经皮冠状动脉介入治疗中的价值及安全性评价[J].中西医结合心脑血管病杂志,2016,14(2):158-160.
[9]OZ T K,EREN M,ATASOY I,et al.Are biventricular systolic functions impaired in patient with coronoray slow flow?A prospective study with three dimensional speckle tracking[J].Inter J Cardiovasc Imaging,2017,33(5):675-681.
[10]简立国,刘士超,王鹏飞,等.血栓抽吸导管联合替罗非班对急性ST段抬高型心肌梗死恢复心肌“再灌注”的近期临床疗效观察[J].中国循环杂志,2014,29(7):501-504.
[11]李永星,郭华,贾宇彤,等.急性心肌梗死患者急症经皮冠状动脉介入术后靶血管校正的TIMI帧数与局部心肌收缩功能关系的研究[J].中国中西医结合急救杂志,2015,22(1):90-93.
[12]BRENER S J,OLDROYD K G,MAEHARA A,et al.Outcomes in patients with ST-segment elevation acute myocardial infarction treated with clopidogrel versus prasugrel(from the INFUSE-AMI trial)[J].Am J Cardiol,2014,113(9):1457-1460.
[13]卓杨,殷兆芳,张阳,等.校正的TIMI帧数评估血栓抽吸在急性ST段抬高型心肌梗死中的疗效[J/CD].中国医学前沿杂志(电子版),2014,6(12):36-39.
[14]GULEL O,AKCAY M,SOYLU K,et al.Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon:A Study of Speckle Tracking Echocardiography[J].Echocardiog,2016,33(5):714-723.
[15]AGHAJANI H,FAAL M,HOSSEINSABET A,et al.Evaluation of left atrial function via two-dimensional speckle-tracking echocardiography in patients with coronary artery ectasia[J].J Clin Ultrasound,2017,45(4):231-237.