处理IRA近远端非梗死相关病变对急性心肌梗死病人疗效影响  

EFFECT OF TREATMENT OF PROXIMAL AND DISTAL NON-INFARCT-RELATED ARTERY LESIONS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

作　　者：鞠森[1] 沈健妹[1] 王新敏 李成香[1] 李海云[1] 

机构地区：[1]青岛市黄岛区人民医院心内科,山东青岛266400

出　　处：《青岛大学医学院学报》2017年第4期439-443,共5页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨处理梗死相关血管(IRA)的近远端非梗死相关病变对ST段抬高性心肌梗死(STEMI)病人无复流现象及近期预后的影响。方法 2007年1月—2011年6月,我院心内科收治的行急诊冠状动脉介入治疗(PCI)的STEMI病人中,IRA有两处或两处以上病变者共110例,剔除IRA的近端及远端均有非梗死相关病变的病人7例,其余分为同时处理近端非梗死相关病变组(A组,48例),同时处理远端非梗死相关病变组(B组,55例)。观察术后TIMI血流分级、TIMI心肌灌注分级(TMP分级)、心电图ST段下降幅度、心肌损伤标志物峰值及出院时超声心动图心功能指标和住院期间主要不良心血管事件(MACE)的发生率。结果 B组术后TIMI 3级血流、TMP 3级血流的发生率分别为89.09%和76.34%,A组分别为77.08%和60.42%,B组明显高于A组(χ~2=2.682、7.909,P<0.05),B组ST段下降幅度明显大于A组(t=-5.725,P<0.05),B组肌酸磷酸激酶同工酶峰值和肌钙蛋白T峰值明显低于A组(t=8.370、8.563,P<0.05)。出院时B组左心室射血分数明显高于A组(t=-8.253,P<0.05),B组左心室收缩末期内径和左心室舒张末期内径明显低于A组(t=8.568、6.182,P<0.05)。B组住院期间MACE的发生率明显低于A组(χ~2=6.867,P<0.05)。结论 STEMI病人行急诊PCI时,同时处理IRA近端非梗死相关病变,反而更易引起无复流现象发生,影响左心室功能的恢复及住院期间MACE的发生。Objective To investigate the effect of treatment of proximal and distal non-infarct-related artery（IRA）lesions on no-reflow phenomenon and short-term prognosis in patients with ST-elevation acute myocardial infarction（STEMI）.Methods A total of 110 STEMI patients with two or more IRA lesions were treated with percutaneous coronary intervention（PCI）by our Cardiology Department from January 2007 to June 2011.Seven cases with non-IRA lesions in both proximal and distal IRA were excluded.One hundred and three patients were randomly divided into group A（simultaneous treatment of proximal nonIRA lesions,48 cases）and group B（simultaneous treatment of distal non-IRA lesions,55 cases）.Observations were performed on clinical indices,including postoperative thrombolysis in myocardial infarction（TIMI）and TIMI myocardial perfusion（TMP）grades,the decline degree of ST segment on electrocardiogram,peak values of myocardial injury markers,echocardiographic indices of cardiac function at discharge,and the incidence of in-hospital major adverse cardiac events（MACE）. Results Compared with group A,group B had significantly higher incidence rates of postoperative TIMI 3 and TMP 3 flow（77.08% vs89.09%,χ~2=2.682,P0.05;60.42% vs 76.34%,χ~2=7.909,P0.05）.The decline degree of ST segment in group B was significantly higher than that in group A（t=-5.725,P0.05）.Group B had significantly lower peak values of creatine phosphokinase isoenzyme and troponin T than group A（t=8.370,8.563;P0.05）.Left ventricular ejection fraction at discharge in group B was significantly higher than that in group A（t=-8.253,P0.05）.Compared with group A,group B had significantly lower left ventricular end-systolic diameter and left ventricular end-diastolic diameter at discharge in group B（t=8.568,6.182;P0.05）.Group B also had a significantly lower incidence of in-hospital MACE than group A（χ~2=6.867,P0.05）. Conclusion In patients with STEMI undergoing primary PCI,treatment of non-IRA lesions in proximal IRA ma

关 键 词：心肌梗死 冠状动脉疾病 血管成形术 气囊 冠状动脉 无复流现象 治疗结果 

分 类 号：R542.22[医药卫生—心血管疾病]