易化PCI与直接PCI对老年急性ST段抬高型心肌梗死术后心室重构与心功能的影响  

Comparison of the influences on postoperative left ventricular remodeling and function between facilitated PCI and primary PCI for elderly acute ST segment elevation myocardial infarction(STEMI)

作　　者：朱传贵[1] 苟华良 郑涛[1] 吴明先[1] 

机构地区：[1]达州市中心医院急诊科,四川达州635000 [2]达州市中心医院心内科,四川达州635000

出　　处：《临床急诊杂志》2016年第10期772-776,共5页Journal of Clinical Emergency

摘　　要：目的:比较易化PCI(即溶栓后即刻PCI)与直接PCI对老年急性ST段抬高型心肌梗死(STEMI)术后心室重构与心功能影响。方法:回顾性分析2012-06-2015-03达州市中心医院收治的163例行PCI治疗的老年STEMI病历资料,其中易化PCI 85例(A组)、直接PCI 78例(B组),比较2组PCI治疗前后血管再通比例、左室射血分数(LVEF)%、峰射血率(PER)、峰充盈率(PFR)、左室收缩末期容积指数(LVESVI)、左室舒张期末容积指数(LVEDVI)、N-末端脑钠肽前体(NT-proBNP)与金属基质蛋白酶-9(MMP-9)。结果:首次冠脉造影显示A组PCI术前IRA再通比例显著高于B组(P<0.05);2组支架成功植入率与支架植入后血管再通比例差异均无统计学意义。2组术后各有1例死于左心衰。2组术后14dLVEF、PER、PFR、LVESVI、LVSF等均较治疗前显著改善,A组术后LVEF显著高于B组(P<0.05),其余术后14d超声心动图指标组间差异均无统计学意义。2组术后NT-proBNP、MMP-9均较治疗前显著下降(P<0.05),术后差异均无统计学意义。结论:对老年STEMI行易化PCI较直接PCI可以提高支架植入前血管再通率与术后射血功能,短期内两种介入方案对AMI患者左室重构的影响相近。Objective：To compare the influences on postoperative left ventricular remodeling and function between facilitated PCI and primary PCI for elderly STEMI.Method：A retrospective analysis was conducted on 163 medical records of elderly STEMI patients underwent PCI treatment of June 2012 to March 2015,of which 85 cases underwent facilitated PCI（group A）,78 cases with primary PCI（group B）,vessel reperfusion ratio of infarct related artery（IRA）,left ventricular remodeling and function indexes and serum biology markers before and after PCI of the two groups were compared.Result：The first coronary angiography showed group A before PCI whose IRA reperfusion ratio（37.6% vs.16.7%）was significantly higher than group B（P〈0.05）.Two groups whose stents successfully implanted rate（97.6% vs.97.4%）and IRA reperfusion ratio after stent implantation（94.0% vs.94.7%）with no statistically significant differences.Each of the two groups had 1cases died of left heart failure（fisher P=1.000）.Compared with pre treatment,LVEF,PER,PFR,LVESVI and LVSF 14 days after PCI of the two groups were significantly improved,and group A whose postoperative LVEF（57.1±5.2vs.55.3±5.5）% was significantly higher than group B（P〈0.05）,remaining postoperative echocardiography indexes of the two groups with no statistically significant differences.Two groups of postoperative MMP-9,NT-proBNP were significantly decreased compared with pre treatment（P〈0.05）,the differences between the groups 14 dafter PCI were not statistically significant.Conclusion：For elderly STEMI patients,the facilitated PCI can improve the IRA＇s patency rate and left ventricular ejection function compared with primary PCI,and the short term effects on left ventricular remodeling of the two kinds of PCI therapy are similar.

关 键 词：急性ST段抬高型心肌梗死 易化经皮冠状动脉介入术 心室重构 心室功能 

分 类 号：R542.2[医药卫生—心血管疾病]