目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后心肌灌注状况对左心功能和结构改变的长期影响.方法:43例AMI患者急诊PCI术后1周内行实时心肌声学造影(MCE),根据造影剂充盈强度分为灌注正常(14例)、灌注稀疏(18例)、灌注缺损(11例)组.随访术后1周、6个月、12个月时左室射血分数(LVEF)、左室舒张末内径(LVIDD),比较组间及组内不同时段LVEF、LVIDD的变化.结果:术后1周时,灌注缺损组LVEF明显低于另两组(P<0.05),LVIDD 3组间无明显差异;而术后6个月、12个月时,灌注缺损组LVIDD明显大于另外两组(P<0.05).与术后1周比较,灌注缺损组LVEF术后12个月时明显下降(P<0.05),LVIDD术后6个月、12个月时明显增大(P<0.05).结论:AMI患者PCI术后心肌微循环灌注较差时,其左心收缩功能减弱、左室内径变大;早期行MCE检测有利于对其长期左心收缩功能改变及左室重构的评估.%Objective To compare changes of left ventricular function and construction in acute myocardial infarction (AMI) patients with different myocardial perfusion status after percutaneous coronary intervention (PCI). Methods 43 AMI patients after PCI were classified into normal perfusion group (n = 14), few perfusion group (n = 18) and defective perfusion group (n = 11) according to the results of real-time myocardial contrast echocardiography (MCE). Left ventricular ejection fraction(LVEF) and left ventricular internal dimension-diastole (LVIDD) were measured on the first week, the sixth month and the twelfth month after PCI. The levels of LVEF and LVIDD were compared among three groups. Results Patients in defective perfusion group had lower LVEF than other two groups all the time(P 〈 0.01). There was no significant difference in LVIDD among three groups on the first week, while on the sixth and twelfth month LVIDD of defective perfusion group was more larger than that of two others (P 〈 0.01). Defective perfusion group had decreased LVEF and increased LVIDD on the twelfth month compared to the first week (P 〈 0.05). Conclusion AMI patients after PCI with less myocardial perfusion would have more lower LVEF and more larger LVIDD one year later.
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