急性心肌梗死患者行急诊与择期经皮冠状动脉介入术的临床疗效对比  

Comparative study on effect of patients with acute myocardial infarction between emergency PCI and elective PCI

作　　者：郭萌[1] 刘利军[1] 张春德[1] 余传庆[1] 

机构地区：[1]淮南市第一人民医院心血管内科,安徽淮南232000

出　　处：《新疆医科大学学报》2018年第3期304-307,共4页Journal of Xinjiang Medical University

基　　金：安徽省淮南市高校创新团队与医疗卫生事业项目(2016A26(3))

摘　　要：目的探讨经皮冠状动脉介入术(PCI)的时机对急性心肌梗死患者疗效、心脏事件发生率及心肌改善情况的影响。方法选择2012年8月-2016年8月在本院心血管科收治的108例急性心肌梗死患者,根据患者就诊时发病时间,其中发病时间在12~24h者为急诊组(n=59),发病超过24h者为择期组(n=49),急诊组患者予以就诊当日行急诊PCI术,择期组常规药物治疗,7~14d后行PCI术,观察两组患者治疗前后左心功能、PCI术后即刻有效率及住院期间、出院后3个月内心血管意外事件发生率。结果 (1)治疗后1个月,两组患者左心室射血分数(LVEF)和左心室收缩末期容积(LVESV)均较治疗前改善,差异具有统计学意义(P<0.05)。急诊组患者LVEF与LVESV改善优于择期组,差异具有统计学意义(P<0.05);(2)急诊组中PCI术后即刻成功率为96.61%;择期组为87.75%,两组患者术后即刻成功率比较差异具有统计学意义(χ~2=3.061,P=0.039);(3)住院期间急诊组中共有13例患者发生心脏意外事件,择期组中共有24例,两组心脏事件发生率比较差异具有统计学意义(χ~2=8.630,P=0.003)。在患者出院3个月随访期间,急诊组心脏意外事件总发生例数明显少于择期组,差异具有统计学意义(χ~2=6.007,P=0.014)。结论选择PCI术的时机对心肌梗死患者的临床疗效、心脏事件发生率以及心肌改善情况存在着较大的影响,为提高疗效、降低患者心脏事件发生率和改善心肌缺血,对于发病时间在12~24h的患者可考虑行急诊PCI治疗。Objective To investigate the effect of percutaneous coronary intervention(PCI)opportunity on the efficacy,the incidence of cardiac events and the myocardium improvement of AMI patients.MethodsA total of 108 patients with acute myocardial infarction were enrolled in our hospital from March 2012 to August 2016.According to the patients′time lag from onset to seeing doctor,59 cases whose time lag were in 12-24 hours were divided into emergency group,while 49 cases whose time lag were more than 24 hours came into the elective PCI group.The patients in emergency group were given emergency PCI surgery on the admission day,while routine medication was given on the elective PCI group and PCI was performed on 7 to 14 days.The left heart function before and after treatment,the immediate efficiency after PCI and the incidence of cardiovascular accidents in hospital and within 3 months after discharge from hospital were recorded and compared.Results(1)One month after treatment,left ventricular ejection fraction(LVEF)and left ventricular end-systolic volume(LVESV)were improved in both groups compared with before treatment,and the difference was statistically significant(P <0.05).The improvement of LVEF and LVESV in emergency group was better than that in elective PCI group,the difference was statistically significant(P <0.05);(2)In the emergency group,the immediately success rate after the PCI operation was 96.61%and in the elective group was 87.75%.The two groups of patients′immediately successful rate after the surgery was statistically different(χ~2=3.061,P =0.039);(3)Thirteen patients in the emergency department during hospitalization experienced a cardiac event with a total of 24 in the elective PCI group.The incidence of cardiac events in the two groups was statistically different(χ~2=8.630,P=0.003).During the three months follow-up of patients discharged from hospital,the total incidence of cardiac events in emergency group were significantly less than the elective group,and the differences were statistically sig

关 键 词：经皮冠状动脉介入术 急性心肌梗死 心脏事件 疗效 

分 类 号：R541.4[医药卫生—心血管疾病]