再灌注时机对急性ST段抬高型心肌梗死患者预后的影响  

Influence of percutaneous coronary intervention timing on the prognosis of patients with acute ST-segment elevation myocardial infarction

作　　者：王丽[1] 翟真[1] 王海连[1] 康秀华[1] 韩龙飞 李静[2] 

机构地区：[1]清华大学玉泉医院心内科,北京100040 [2]首都医科大学宣武医院心内科,北京100053

出　　处：《中华实用诊断与治疗杂志》2018年第1期39-41,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81470491)

摘　　要：目的探讨急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗时机对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的影响。方法接受急诊PCI术治疗急性STEMI患者183例,其中发病至梗死相关血管再通时间≤6h者97例为观察组,>6~12h者86例为对照组,分别于发病48h内及PCI术后1a时行超声心动图检测左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)和左室射血分数(left ventricular ejection fraction,LVEF),记录PCI术后1a主要心脏不良事件发生情况。结果对照组PCI术后1a时LVESD[(34.48±3.17)mm]、LVEDD[(52.49±3.69)mm]、LVEF[(49.73±3.42)%]与发病48h内[(38.97±3.14)mm、(53.84±3.28)mm、(47.64±5.76)%]比较差异均无统计学意义(P>0.05);观察组PCI术后1a时LVESD[(32.99±3.73)mm]、LVEDD[(47.95±3.74)mm]低于发病48h内[(39.15±2.74)、(54.36±3.62)mm],LVEF[(55.37±3.68)%]高于发病48h内[(46.72±5.42)%](P<0.05),且LVESD、LVEDD低于对照组,LVEF高于对照组(P<0.05);PCI术后1a,观察组再次PCI治疗、再发心肌梗死、再发心绞痛、恶性心律失常、心力衰竭发生率和心血管病死率(5.15%、5.15%、8.25%、4.12%、4.12%、6.19%)均低于对照组(17.44%、19.77%、23.26%、12.80%、16.28%、13.95%)(P<0.05)。结论急性STEMI确诊后应采取措施在发病6h内接受PCI术治疗,以改善远期预后。Objective To evaluate the influence of pereutaneous coronary intervention （PCI） timing on the prognosis of patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 183 patients with STEMI were divided into observation group （infarct related artery opened 〈 6 h, n〈 97） and control group （infarct related artery opened in 6 to 12 h, n=86）. In 48 h after onset and 1 year after PCI, echocardiography was performed to determine the left ventricular end-systolic dimension （LVESD）, left ventricular end-diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF）, and the incidences of major adverse cardiovascular events were recorded and compared between two groups. Results LVESD （（34.48＋3.17） ram）, LVEDD （（52.49：[：3.69） ram） and LVEF （（49. 734-3.42）〈） in 1 year after PCI showed no significant differences in comparison with those in 48 h after onset in control group （P〈0.05）. LVESD （（32.99＋3. 73） ram） and LVEDD （（47. 95 i 3. 74） ram） were significantly shorter and LVEF （（55. 37 ：[： 3.68） 〈） was significantly higher in 1 year after PCI than those in 48 h after onset （（39. 15-4-2. 74）, （54.36 〈 3.62） mm, （46.72 〈 5.42）〈 ） in observation group （P（0.05）, and LVESD and LVEDD were significantly shorter and LVEF was significantly higher in observation group than those in control group （P（0.05）. The rates of secondary PCI, recurrent myocardial infarction, recurrent angina, malignant arrhythmia, heart failure and cardiovascular mortality in observation group （5.15%, 5.15%, 8.25%, 4. 12%, 4.12%, 6.19%） were significantly lower than those in control group （17.44%, 19.77%, 23.26%, 12.80G, 16.28%, 13.95%） in 1 year after PCI （P〈0.05）. Conclusion PCI should be performed in 6 h after the onset of acute STEMI in order to improve the long-term prognosis.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入术 再灌注时机 预后 

分 类 号：R542.22[医药卫生—心血管疾病]