目的 探讨经皮冠状动脉介入治疗(PCI)术在缺血性心肌病(ICM)治疗中的作用和意义.方法 选取我院收治的ICM患者共60例,根据造影结果及患者所选治疗方案分成2组,保守治疗组28例,冠状动脉造影后按ICM指南给予药物治疗；PCI组32例,冠状动脉造影后对病变血管植入国产药物支架,并按ICM指南服用药物,观察、记录治疗前、治疗后12个月纽约心脏病协会(NYHA)心功能分级、6mim步行试验(6MWT)分级和心脏彩色多谱勒超声检查测得的左心室射血分数、每搏输出量、心输出量等指标.结果 术后12个月内保守治疗组住院14例次,死亡3例(9.4％)；PCI组住院7例次,死亡1例(3.6％)；PCI组患者住院例次及病死率明显低于保守治疗组(均P＜0.05).术后12个月时,PCI组NYHA分级为Ⅰ级7例,Ⅱ级17例,Ⅲ级5例,Ⅳ级2例；保守治疗组NYHA分级为Ⅰ级2例,Ⅱ级6例,Ⅲ级12例,Ⅳ级5例；2组NYHA分级差异有统计学意义(P＜0.05).PCI组术后12个月6MWT分级为Ⅰ级14例,Ⅱ级13例,Ⅲ级3例,Ⅳ级l例；保守治疗组为Ⅰ级5例,Ⅱ级8例,Ⅲ级10例,Ⅳ级2例；2组6MWT分级差异有统计学意义(P＜0.05).PCI组术后12个月左心室射血分数、每搏输出量、心输出量明显高于术前及保守治疗组术后12个月,差异有统计学意义[左心室射血分数:(44±5)％比(33±5)、(40±3)％；每搏输出量:(61±6)ml比(32±3)、(48±6)ml；心输出量:(4.38±1.50) L/min比(3.40±0.57)、(3.52±0.76) L/min,均P＜0.05].结论 PCI术对ICM具有较好的治疗作用,对改善其远期预后具有重要的意义.%Objective To observe and compare different symptoms and prognosis of before and after treatment patients with ischemic cardiomyopathy (ICM) ; to explore the role and significance of percutaneous coronary intervention(PCI) surgery in the treatment of patients with ischemic cardiomyopathy.Methods All 60 in-hospital cases with ICM,according to coronary artery angiography results and treatment options,were divided into two groups:conservative medical treatment group(28 patients) received drug treatment after angiography and PCI group (32 cases) took regularly drug after implantation drug-eluting stent(made in China).After 12 months,cardiac function,echocardiography results were observed and recorded.Results Before treatment,the two groups have no significant differences in cardiac function and color doppler ultrasound(P ＞0.05).12 months later,there were significant differences with cardiac function in two groups [left ventricular ejection fraction:(44 ± 5)％ vs (33 ± 5),(40 ±3)％ ; stroke volume:(61 ±6)ml vs(32 ±3),(48 ±6)ml; cardiac output:(4.38 ± 1.50)L/min vs(3.40 ±0.57),(3.52 ± 0.76) L/min,all P ＜ 0.05].Conclusion Treatment of PCI for ischemic cardiomyopathy has an optimistc therapeutic effect.
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