AMI患者行急诊与择期PCI的术后心功能比较  

Clinical trial on postoperative heart function of emergency PCI and selective PCI in patients with AMI

作　　者：孙源慧 黄静[2] 王曙光[2] 陈彦波[2] 张俊刚[2] 王健[2] 张爱元[2] Yuan-hui Sun;Jing Huang;Shu-guang Wang;Yan-bo Chen;Jun-gang Zhang;Jian Wang;Ai-yuan Zhang(Department of Cardiology,Affiliated Hospital of Weifang Medical University,Weifang,Shandong 261031,China;Department of Cardiology,Weifang People’s Hospital,Weifang,Shandong 261041,China)

机构地区：[1]潍坊医学院附属医院心内科,山东潍坊261031 [2]潍坊市人民医院心内科,山东潍坊261041

出　　处：《中国现代医学杂志》2018年第20期89-92,共4页China Journal of Modern Medicine

摘　　要：目的比较急性前壁心肌梗死患者6~12 h行急诊经皮冠状动脉介入治疗(PCI)与择期PCI的术后心功能情况。方法患者均在入院当天行心脏彩超检查,并于入院当日及每隔1天监测血浆氨基末端B型利钠肽前体(NT-pro BNP)、肌钙蛋白Ⅰ(CTNI)。10 d后再次行上述检查并进行分析。结果急诊组出入院左心室舒张末内径(LVEDd)比较无差异(P>0.05),而左心室射血分数(LVEF)出院较入院下降(P<0.05);择期组LVEDd出院较入院增大(P<0.05),LVEF出院较入院下降(P<0.05)。两组出入院LVEDd、LVEF的差值比较有差异(P<0.05)。急诊组NT-pro BNP峰值及CTNI峰值均低于择期组(P<0.05)。结论急性前壁心肌梗死患者6~12 h行急诊PCI术或择期PCI术,术后近期心功能均会一过性下降,择期组较急诊组下降更显著,提示患者发病>6 h已无症状,行急诊PCI术对患者术后心功能仍有积极作用,机制可能与急诊PCI术尽早恢复血运重建,更早、更多地挽救存活心肌有关。Objective To evaluate the postoperative heart function of patients with acute anterior myocardial infarction(AMI)receiving emergency percutaneous coronary intervention(PCI)within 6-12 h of attack or selective PCI.Methods Seventy-seven patients wih AMI were divided into an emergency PCI group(30 cases)and a selective PCI group(47 cases).The patients in the emergency PCI group received emergency PCI within 6 to 12 hours after attack,the patients in the selective PCI group were treated by elective PCI(over 12 hours)after 7 to 10 days.LVEDd,LVEF,NT-proBNP and cardiac troponin I(CTNI)were monitored on the day of admission,every other day and 10 days later,then compared between the two groups.Results In the emergency PCI group,LVEDd at the time of admission and discharge had no significant difference(P>0.05),while the LVEF decreased at discharge(P<0.05).In the selective PCI group,the LVEDd increased and LVEF significantly decreased at discharge(P<0.05).The differences of LVEDd and LVEF at admission and discharge were significantly different between the two groups(P<0.05).The NT-proBNP and CTNI levels of the emergency PCI group were significantly lower than those of the selective PCI group(P<0.05).Conclusions The heart function will decline in a short time in the patients with AMI undergoing emergency PCI within 6-12 h of attack or selective PCI,but it decreases more in the selective PCI group than in the emergency PCI group,which indicates that emergency PCI operation within 6-12 h of attack has positive effect on the cardiac function of AMI patients.The mechanism may be that emergency PCI operation can provide revascularization as soon as possible and save more survival myocardium.

关 键 词：急性心肌梗死 急诊经皮冠状动脉介入治疗术 择期经皮冠状动脉介入治疗术 心功能 

分 类 号：R541.4[医药卫生—心血管疾病]