再灌注时间对急诊冠状动脉介入治疗心肌灌注的影响  

Effect of time-to-reperfusion on myocardial reperfusion after primary coronary intervention for acute myocardial infarction

作　　者：郑宏超[1] 崔克俭[1] 曹维锷[1] 张亚臣[2] 顾水明[1] 

机构地区：[1]上海市徐汇区中心医院心内科,200031 [2]上海交通大学医学院附属新华医院,200092

出　　处：《国际心血管病杂志》2008年第4期247-249,共3页International Journal of Cardiovascular Disease

摘　　要：目的:分析再灌注时间对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及近期预后的影响。方法:101例首发STEMI并行急诊PCI的患者按症状发作至再灌注的时间(t)分为3组:t≤3h为A组,37例;3h<t≤6h为B组,31例;6h<t≤12h为C组,33例。分析各例冠状动脉造影心肌呈色分级(MBG)和心电图ST段回落指数(STR),并进行临床随访。结果:3组患者PCI术后达到TIMI 3级血流的比例无显著差异(P>0.05)。B组及C组PCI术后MBG0/1(58.06%、57.58%)和ST段回落不全(STR<50%)的比例(51.61%、54.55%)均高于A组(32.43%和27.03%,P<0.05),B组与C组间MBG、STR无统计学差异(P>0.05)。B组及C组在30d随访期间的死亡率、Killip分级和心源性休克发生率均显著高于A组(P<0.05)。结论:在STEMI急诊PCI中,12h内不同时间组获得TIMI 3级血流的比例相同,但再灌注时间<3h的患者心肌组织灌注水平提高,近期预后较好。Objective： To evaluate the effect of time-to-reperfusion on myocardial reperfusion and prognosis after primary percutaneous coronary intervention （PCI） in ST elevation acute myocardial infarction （STEMI）. Methods： A total of 101 patients with first STEMI undergoing primary PCI were divided into three groups according to time-to-reperfusion（t） ： group A （t ≤3h, n = 37）, group B （3h〈t≤6h, n = 31） and group C （6h〈t≤12h, n= 33）. Myocardial perfusion was assessed by myocardial blush grade （MBG） and ST-segment elevation resolution （STR）. Results：Post procedural TIMI-3 flow was similar among the three groups （P〉0.05）. Compared with group A,the incidence of poor myocardial perfusion （MBG 0/1） in group B and C was significantly increased （58.06% vs. 57.58% vs. 32.43% ,P〈0.05）. The occurrence rate of STR （STR〈50%） reach at 27.03% in group A,which was significantly lower than that of group B （51.61%） and group C （54.55%） （P〈0. 05）. During 30 days follow-up, mortality, Killip grade, cardiogenic shock were all significantly higher in group B and group C than that in group A （P〈0.05）. Conclusion：Despite similar TIMI-3 flow after primary PCI, patients with STEMI with time-to-reperfusion ≤3h are more likely to have better myocardial perfusion after primary PCI and favorable clinical outcome during follow-up.

关 键 词：再灌注 心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]