急性ST段抬高心肌梗死合并肺部感染患者溶栓后转运行PCI临床效果分析  

Clinical Analysis of Thrombolysis before Transportation for PCI in Patients with Acute ST Segment Elevation Myocardial Infarction Complicated with Pulmonary Infection

作　　者：李哲 明辉[2] 李凤杰[1] LI Zhe;MING Hui;LI Feng-jie(Beijing Luhe Hospital,Capital Medical University,Beijing 101100)

机构地区：[1]首都医科大学附属北京潞河医院,北京101100 [2]北京市普仁医院,北京100062

出　　处：《医学临床研究》2019年第12期2302-2304,共3页Journal of Clinical Research

基　　金：首都卫生发展科研专项基金(首发2018-4-4238)。

摘　　要：【目的】探讨急性ST段抬高心肌梗死(STEMI)合并肺部感染患者溶栓后转运行经皮冠脉介入治疗(PCI)临床效果。【方法】选择2016年1月至2018年12月本院收治的200例STEMI合并肺部感染行PCI治疗患者,根据患者转诊前是否行溶栓治疗分为观察组(n=76,转运前溶栓治疗)和对照组(n=124,转运前未行溶栓治疗)。观察两组患者左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)等变化情况。比较两组患者治疗前、治疗后7 d血清降钙素原(PCT)、C反应蛋白(CRP)水平。随访患者半年,观察两组患者不良事件发生情况。【结果】治疗后,两组患者LVEDD、LVESD低于治疗前,LVEF高于治疗前,观察组LVEDD、LVESD低于对照组,LVEF高于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者血清PCT、CRP水平低于治疗前,观察组低于对照组,差异均有统计学意义(P<0.05)。随访6个月,观察组患者心血管不良事件发生率为5.26%(4/76)低于对照组的14.52%(18/124),差异有统计学意义(χ2=4.121,P=0.042<0.05)。【结论】STEMI合并肺部感染患者溶栓后转运PCI治疗有助于患者心功能恢复及肺部感染的控制,并可降低心血管不良事件发生的风险,值得临床借鉴。【Objective】To investigate the clinical effect of thrombolysis before transporting for PCI in patients with STEMI complicated with pulmonary infection.【Methods】From January 2016 to December 2018,200 patients with STEMI and pulmonary infection who were treated by PCI were divided into observation group(n=76,thrombolysis before transport)and control group(n=124,none thrombolysis before transport)according to whether thrombolysis was performed before referral.The changes of left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESD)were observed.The serum levels of procalcitonin(PCT)and C-reactive protein(CRP)were compared before and 7 days after treatment.The patients were followed up for half a year to observe the adverse events of the two groups.【Results】After treatment,LVEDD and LVESD of the two groups were lower than before treatment,and LVEF was higher than before treatment.LVEDd and LVESD of the observation group were lower than that of the control group,and LVEF was higher than that of the control group,the difference was statistically significant(P<0.05).After treatment,the levels of PCT and CRP in serum of the two groups were lower than that before treatment,and that in the observation group was lower than that in the control group(P<0.05).After 6 months follow-up,the incidence of cardiovascular adverse events in the observation group was 5.26%(4/76)lower than that in the control group(14.52%)(18/124),the difference was statistically significant(χ2=4.121,P=0.042<0.05).【Conclusion】Thrombolysis before transportation for PCI is helpful for the recovery of heart function and the control of pulmonary infection in patients with STEMI complicated with pulmonary infection,and it can reduce the risk of cardiovascular adverse events,which is worthy of clinical reference.

关 键 词：ST段抬高型心肌梗死/并发症 急性病 肺炎/并发症 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]