急性非ST段抬高型心肌梗死早期介入治疗与早期保守治疗预后对比研究  

Comparison of early invasive therapy and early conservative therapy in patients with acute non-ST-segment elevation myocardial infarction

作　　者：孙科远[1] 吴晗[1] SUN Ke-yuan WU Han.(Department of Emergency, the Affiliated Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200336, Chin)

机构地区：[1]上海交通大学医学院附属同仁医院急诊科,上海市200336

出　　处：《中国心血管病研究》2016年第8期712-716,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨急性非ST段抬高型心肌梗死早期介入治疗和早期保守治疗疗效及预后.方法 选取2010年3月至2015年2月在我院心内科住院诊断为急性非ST段抬高型心肌梗死患者160例为研究对象,根据早期治疗策略不同分为早期介入治疗组80例（试验组）和早期保守治疗组80例（对照组）.试验组立即行冠状动脉造影检查,依据造影结果进一步予以经皮冠状动脉介入治疗（PCI）;对照组予以保守治疗1周后行PCI治疗.随访6个月,比较两组患者治疗前后左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和左心室射血分数（LVEF）指标的变化,以及住院和随访期间主要不良事件发生率.结果 术后1周试验组和对照组LVEDV、LVESV和LVEF三项指标比较未见统计学差异（P＞0.05）.与术后l周相比,术后6个月试验组LVEDV[（107.95±24.55）ml/m2比（128.92±30.88）ml/m2]、LVESV[（43.33±12.56）ml/m2比（61.95±17.50）ml/m2]明显降低,LVEF明显升高[（59.92±7.08）％比（51.89±8.08）％]（P均＜0.05）.与术后1周相比,术后6个月对照组LVEDV[（120.74±23.63）ml/m2比（132.89±29.42）ml/m2]、LVESV[（53.26±15.88）ml/m2比（63.40±21.57）ml/m2]明显降低,LVEF明显升高[（56.20±7.59）％比（53.06±8.24）％]（P＜0.05）.术后6个月试验组LVEDV[（107.95±24.55）ml/m2比（120.74±23.63）ml/m2]、LVESV [（43.33±12.56）ml/m2比（53.26±15.88）ml/m2]明显低于对照组,LVEF[（59.92±7.08）％比（56.20±7.59）％]明显高于对照组（P＜0.05）.试验组住院期间心绞痛发生率（1.25％比10.00％）、恶性心律失常发生率（0.00％比6.25％）、梗死复发再次住院率（2.50％比12.50％）和随访期间心源性死亡率（2.50％比11.25％）均低于对照组（P＜0.05）.结论 早期介入治疗和早期保守治疗均可改善急性非ST段抬高型心肌梗死患者心功能.早期介入治疗疗效更显著,且降低了患者住院和随访期�Objective To investigate the acute non-ST segment elevation myocardial infarction（NSTEMI） early invasive therapy and early conservative therapy and prognosis. Methods 160 patients with NSTEMI during March 2010 to February 2015 in our hospital were divided into two groups, early invasive therapy group（experimental group） 80 cases and early conservative therapy group （control group） 80 cases. The experimental group im- mediately underwent coronary angiography, according to the angiographic results could be further percutaneous coronary intervention （PCI）. The control group underwent PCI after conservative therapy one week. Follow-up of six months, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left ven- tricular ejection fraction（LVEF） and the main indicators of change in the incidence of major adverse cardiovascular events during hospitalization and during follow-up were compared before and after treatment in the two groups. Restilts A week after the LVEDV, LVESV and LVEF were no significant difference between experimental group and the control group （P〉0.05）. After six months the LVEDV [ （128.92±30.88）ml/m2 vs （107.95±24.55）ml/m2], LVESV [ （61.95±17.50）ml/m2 vs （43.33±12.56）m1/m2] was significantly reduced in experimental group, LVEF [ （51.89±8.08）% vs （59.92±7.08）% ] was significantly increased（P〈0.05）. After six months, in the control group LVEDV [ （ 132.89±29.42）ml/m2 vs （ 120.74±23.63）ml/m2], LVESV [ （63.40±21.57）ml/m2 vs （53.26±15.88）ml/ m2] was significantly reduced, LVEF[（53.06±8.24）% vs （56.20±7.59）%] was significantly increased（P〈0.05）, after six months the experimental group LVEDV [（107.95±24.55）ml/m2 vs （120.74±23.63）ml/m2], LVESV [ （43.33± 12.56 ）ml/m2 vs （ 53.26± 15.88 ）ml/m2 ] was significantly lower than the control group, LVEF [ （ 59.92± 7.08）% vs （56.20±7.59）% ] was significantly higher（P〈0.05）. The incidence of

关 键 词：急性非ST段抬高型心肌梗死 早期介入治疗 早期保守治疗 预后 

分 类 号：R542.22[医药卫生—心血管疾病]