【摘要】：目的：探討急性心肌梗死患者左室功能的影響因素。 方法：入選2012年1月1日至2012年12月31日因急性心肌梗死（acute myocardialinfarction，AMI）于福建省立醫(yī)院心內(nèi)科行急診或擇期冠狀動脈介入治療（percutaneous coronary intervention，PCI）患者共160例，根據(jù)發(fā)病至PCI時間分為3組，A組：發(fā)病12小時內(nèi)行急診PCI，B組：發(fā)病12小時-7天內(nèi)PCI，C組：發(fā)病8-14天PCI。采用心臟彩色多普勒超聲儀測量AMI患者心梗后7-14天的左室射血分?jǐn)?shù)（Left ventricle ejection fraction，LVEF），并將患者的年齡、性別、血壓、血糖、吸煙、血脂、肌鈣蛋白I值、NT-proBNP值及手術(shù)介入時間等與左室射血分?jǐn)?shù)進(jìn)行相關(guān)分析。 結(jié)果 1、發(fā)病至介入治療時間（t=－2.354，P=0.02）與AMI患者LVEF值呈負(fù)相關(guān)。A組的LVEF顯著高于C組的LVEF值，差異有統(tǒng)計學(xué)意義（P0.05）；A組與B組、B組與C組的LVEF值差異無統(tǒng)計學(xué)意義（P0.05）；本組資料中，AMI最常見血管病變?yōu)?支血管病變，冠脈單支病變組的LVEF值顯著高于冠脈多支病變組的LVEF值，差異有統(tǒng)計學(xué)意義（P0.05）。 2、多元回歸分析顯示在調(diào)整其他因素的影響后，肌鈣蛋白I值（t=-3.409，P=0.001）、N端-B型鈉尿肽前體值（t=-5.484，P=0.000）、空腹血糖異常（t=-2.872，P=0.043）、冠脈病變支數(shù)（t=-3.390，P=0.001）與急性心肌梗死患者LVEF值成負(fù)相關(guān)，高血壓�。╰=0.052，P=0.959）、糖尿�。╰=-0.291，P=0.771）、糖化血紅蛋白（t=-1.272，P=0.205）及餐后2小時血糖（t=0.052，P=0.958）、吸煙（t=－0.658，P=0.511）、總膽固醇（t=0.893，P=0.373）、甘油三酯（t=0.711，P=0.478）、低密度脂蛋白膽固醇（t=-0.803，，P=0.423）、高密度脂蛋白膽固醇（t=-1.147，P=0.253）等與急性心肌梗死患者LVEF值無明顯相關(guān)性。 結(jié)論 1、AMI在發(fā)病12小時內(nèi)行PCI術(shù)的患者LVEF值保留情況較8天后行PCI術(shù)者好；本組資料中，AMI最常見血管病變?yōu)?支血管病變，單支血管受累的AMI患者LVEF明顯優(yōu)于多支血管受累者。 2、介入治療時間、肌鈣蛋白I值、N端－B型鈉尿肽前體值、空腹血糖異常、冠脈病變數(shù)與急性心肌梗死患者LVEF值呈負(fù)相關(guān)，可以作為梗死后評價心功能的敏感指標(biāo)及獨立的預(yù)測因子。
[Abstract]:Objective: to investigate the influencing factors of left ventricular function in patients with acute myocardial infarction. Methods: from January 1, 2012 to December 31, 2012, 160 patients with acute myocardial infarction (acute myocardialinfarction,AMI) underwent emergency or selective coronary intervention therapy (percutaneous coronary intervention,PCI) in the Department of Cardiology, Fujian Provincial Hospital. According to the time from onset to PCI, they were divided into three groups: group A: emergency PCI,B group within 12 hours of onset: PCI,C group within 12 hours to 7 days of onset: PCI. on 8-14 days of onset Left ventricular ejection fraction (Left ventricle ejection fraction,LVEF) was measured 7-14 days after myocardial infarction in patients with AMI by color Doppler echocardiography. Age, sex, blood pressure, blood glucose, smoking, blood lipid were measured. Cardiac troponin I and NT-proBNP were correlated with left ventricular ejection fraction (LVEF). Results (1) the time from onset to interventional therapy (tn 2.354) was negatively correlated with the LVEF value of AMI patients. The LVEF of group A was significantly higher than that of group C (P0.05). There was no significant difference in LVEF between group A and group B and group C (P0.05). Three vessel lesions were the most common vascular lesions in this group. The LVEF value in the single vessel lesion group was significantly higher than that in the multi-vessel coronary artery disease group, and the LVEF value in the single vessel lesion group was significantly higher than that in the multi-vessel coronary artery disease group. The difference was statistically significant (P0.05). 2. Multiple regression analysis showed that after adjusting for other factors, There was a negative correlation between the N-terminal natriuretic peptide precursor (TV-5.484), the abnormal fasting blood glucose (t-2.872), and the number of coronary artery lesion (t-3.390g / P0.001) in patients with acute myocardial infarction (AMI), and the level of troponin I (t-3.409) was negatively correlated with the LVEF value in patients with acute myocardial infarction (AMI). Hypertension (t0. 052), diabetes mellitus (t-0. 291), glycosylated hemoglobin (t-1. 272), postprandial blood glucose (t-0. 052), smoking (t-0. 658P0. 511), total cholesterol (t-0. 893), triglyceride (t-0. 111), low density lipoprotein cholesterol (t-0. 803, P 0. 423), high density lipoprotein cholesterol (t-1. 147, P 0. 253) and other patients with acute myocardial infarction There was no significant correlation between LVEF values. Conclusion (1) the retention of LVEF in patients with PCI within 12 hours after onset is better than that in patients with PCI after 8 days, and the most common vascular lesions in this group are three vessel lesions. LVEF in patients with single vessel involvement was significantly better than that in patients with multiple vessel involvement. 2. Interventional therapy time, cardiac troponin I value, N-terminal natriuretic peptide precursor, fasting blood glucose abnormality, The number of coronary artery lesions was negatively correlated with the LVEF value of patients with acute myocardial infarction, which could be used as a sensitive index and an independent predictor for evaluating cardiac function after infarction.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R542.22

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