经桡动脉入径直接经皮冠状动脉介入术联合单硝酸异山梨酯治疗急性ST段抬高型心肌梗死患者临床效果分析  

Effect of direct PCI via radial artery combined with isosorbide mononitrate on brain natriuretic peptide and cardiac index in patients with STEMI

作　　者：赵躬英 黄刚[1] 张眉[1] 王蕾[1] 林霞 ZHAO Gong-ying;HUANG Gang;ZHANG Mei;WANG Lei;LIN Xia(Department of Cardiology,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院心血管内科,四川遂宁629000 [2]遂宁市中心医院急诊科,四川遂宁629000

出　　处：《临床军医杂志》2019年第2期146-149,共4页Clinical Journal of Medical Officers

基　　金：遂宁市市级课题基金项目(2014528)

摘　　要：目的探讨经桡动脉入径行直接经皮冠状动脉介入术(PCI)联合单硝酸异山梨酯治疗急性ST段抬高型心肌梗死(STEMI)患者的临床效果。方法选取自2015年1月至2018年1月遂宁市中心医院收治的200例行急诊PCI术的STEMI患者为研究对象,采用随机数字表法将患者分为A、B、C、D共4组,每组各50例。A组予以股动脉入径PCI以及常规治疗;B组予以股动脉PCI,在常规药物治疗基础上加用单硝酸异山梨酯; C组予以桡动脉入径PCI以及常规治疗; D组予以桡动脉PCI,在常规药物治疗基础上加用单硝酸异山梨酯。观察4组患者术中血管血流情况以及出血量;比较4组患者手术前、后心功能(Killip)分级,治疗前、后的B型脑钠肽(BNP)、左室射血分数(LVEF)、心脏指数(CI)等心功能指标以及治疗期间不良事件、主要不良心血管事件(MACE)发生情况。统计入住冠心病监护病房(CCU)以及总住院的时间。结果 4组患者罪犯血管分布情况、TIMI血流3级比例比较,差异均无统计学意义(P> 0. 05)。A、B两组患者术中出血量均显著高于C、D两组,差异均有统计学意义(P <0. 05)。4组患者治疗前、后Killip分级比较,差异均无统计学意义(P> 0. 05)。4组患者治疗后BNP均显著低于治疗前,且B、D两组均低于A、C两组,差异均有统计学意义(P <0. 05)。4组患者LVEF、CI均高于治疗前,且B、D两组高于A、C两组,差异均有统计学意义(P <0. 05)。4组患者CCU住院时间比较,差异无统计学意义(P> 0. 05)。B、D两组患者总住院时间均显著低于A、C组,差异均有统计学意义(P <0. 05)。结论经桡动脉入径直接PCI联合单硝酸异山梨酯治疗STEMI患者可较好的改善患者BNP、LVEF、CI等心功能指标,同时具有术中出血量少、住院时间短等优点。Objective To investigate the effect of direct PCI through radial artery approach combined with isosorbide mononitrate in the treatment of STEMI patients and the effects on brain natriuretic peptide and cardiac index. Methods A retrospective study was performed on 200 cases of STEMI patients who underwent PCI from January 2015 to January 2018. Patients were randomly divided into the Group A,Group B,Group C and Group D,with 50 cases in each group. Patients in Group A were treated with PCI and conventional treatment. Patients in Group B were given femoral artery PCI,and isosorbide mononitrate was added on the basis of conventional drug treatment. Patients in Group C were treated with radial artery approach PCI and conventional treatment. Patients in Group D were given radial artery PCI,and isosorbide mononitrate was added on the basis of conventional drug treatment. The intraoperative blood flow and blood loss of the four groups were observed. Four groups of patients were compared in terms of their pre-operative and post-operative heart function( Killip) grades,pre-treatment and post-treatment brain natriuretic peptide( BNP),left ventricular ejection fraction( LVEF),cardiac index( CI) and other cardiac function indicators,as well as the occurrence of adverse events and major adverse cardiovascular events( MACE) during the treatment. Coronary care unit( CCU) and total hospital stay were calculated. Results There was no significant difference in criminals’ vascular distribution and TIMI blood flow grade 3 ratio between the four groups( P > 0. 05). Intraoperative blood loss in Group A and B was significantly higher than that in Group C and D( P < 0. 05). Comparison of Killip grades be-fore and after treatment among the four groups showed no statistical significance( P > 0. 05). BNP was significantly lower in the four groups after treatment than before treatment,and lower in Group B and D than that in Group A and C( P < 0. 05). LVEF and CI of the patients in the four groups were higher than those before treatment,and

关 键 词：经皮冠状动脉介入治疗 急性ST段抬高型心肌梗死 单硝酸异山梨酯 心功能 脑钠肽 心脏指数 

分 类 号：R542.22[医药卫生—心血管疾病]