急性心肌梗死冠状动脉侧支血流分数及左室功能关系探析.docVIP

急性心肌梗死冠状动脉侧支血流分数及左室功能关系探析 　 作者：蔡志雄， 王晓青， 蓝斌， 胡莲清， 陈平， 朱稚丹， 郭舜奇， 罗燕华 【摘要】 　　【目的】 测定压力源性的冠状动脉侧支血流分数，评价其与传统的Rentrop分级间的相关性；并探讨该冠状动脉侧支血流分数与急性心肌梗死直接经皮冠状动脉介入治疗成功后左室功能变化之间的关系。【方法】 29例急性心肌梗死患者行直接经皮冠脉介入术，术中用冠状动脉内压力导丝根据“病变远端楔嵌压/主动脉平均压”计算冠脉侧支血流分数，以0.24为截值将29例分为两组：A组（19例）冠状动脉侧支血流分数gt;0.24，B组（10例）侧支血流分数≤0.24。术后根据冠状动脉造影行Rentrop分级。采用Simpsons测左室射血分数、左室收缩及舒张末期容积，计算相关的容积指数。【结果】 Rentrop分级与压力源性的冠状动脉侧支血流分数呈正相关性，该冠状动脉侧支血流分数同30d后左室射血分数呈正相关性。【结论】 冠状动脉内压力源性的侧支血流分数可预测临床成功的直接经皮冠脉介入术后左室功能的恢复，并可对急性心肌梗死时侧支循环血流作出定量评价。 【关键词】 心肌梗死　急性； 侧支循环； 侧支血流分数 Abstract:【Objective】 1.To investigate the correlation between pressure-derived collateral fractional flow (PDCF) and Rentrop grade. 2.To evaluate the relation between PDCF and left ventricular recovery function after primary percutaneous coronary intervention(PCI). 【Method】 The PDCF,determined by the ratio of Pw/Pa, was measured in 29 patients with first acute myocardial infarction (AMI) treated by primary PCI whose onset waslt;12hr.Sufficient collateral (Group A) was defined as PDCFgt;0.24 and insufficient collateral (Group B) as PDCF≤0.24. Rentrop grade of collateral was evaluated by coronary angiography. Echocardiography was performed on the 3th and 30th day after PCI. Left ventricular ejection fraction, end systolic and diastolic volume, and the related indexes were obtained. 【Result】 Rentrop grade was significantly related to PDCF, but a wide range of PDCF was observed in patients with Rentrop grade≤1. 【Conclusion】 PDCF can predict left ventricular recovery after successful PCI, and evaluate the collateral flow mensurably with AMI. Key words: acute myocardial infarction; collateral circulation; pressure-derived collateral fractional flow [J SUN Yat-sen Univ(Med Sci), 2007, 28(1): 97-100] 左室功能是急性心肌梗死患者长期预后的最重要预测指标之一[1]，已有研究表明及早开通梗死相关动脉可显著提高患者的生存率，但却不能保证左室功能恢复[2]，这种差异提示存在有非时间依赖的独立于再灌注心肌拯救机制的因素影响梗死后心功能的变化。Sugiura T等[3，4]报导，冠状动脉侧枝循环血流在心梗过程中对缺血心肌具有保护作用，可改善心功能、提高生存率，但由于缺乏评价冠状动脉侧枝循环的精确方法，致使目前关于侧支循环在急性心肌梗死中的意义仍存有争议[5-7]。本研究旨在探讨压力源性的冠状动脉侧支血流分数（pressure?鄄d