不同冠脉血运重建策略对急性心肌梗死心肌存活性的影响  

Effects of Different Coronary Artery Revascularization Strategies on Myocardial Survival in Patients with Acute Myocardial Infarction

作　　者：魏翰文 范晓涌 胡海英 佟勤红 王银娣 张玉峰 张钊 汉军成 WEI Han-wen;FAN Xiao-yong;HU Hai-ying;TONG Qin-hong;WANG Yin-di;ZHANG Yu-feng;ZHANG Zhao;HAN Jun-cheng(Department of Cardiology,the First People's Hospital of Lanzhou City,Lanzhou,Gansu Province,730050 China)

机构地区：[1]甘肃省兰州市第一人民医院心内科,甘肃兰州730050

出　　处：《系统医学》2020年第21期43-46,共4页Systems Medicine

基　　金：兰州市科技局人才创新创业项目(2015-RC-57)。

摘　　要：目的探讨不同血运重建策略对急性心肌梗死患者心肌存活性的影响。方法选取2016年1月—2018年2月该院收治的127例急性心肌梗死患者为研究对象,以64排CT检查结果分为梗死区心肌有存活组和无存活组,对比两组患者临床特点及静脉溶栓、急诊PCI、补救性PCI资料。结果有存活心肌组急诊PCI开通梗死相关冠脉(IRA)距症状时间≤6 h的患者比例为67.9%,无存活心肌组为38.1%,差异有统计学意义(χ^2=8.415,P=0.004);有存活心肌组急诊静脉溶栓距症状发作时间在>6 h的患者比例为20.0%,无存活心肌组患者为66.7%,有存活心肌组明显比无存活心肌组较小,差异有统计学意义(χ^2=4.791,P=0.029);有存活心肌组行补救性PCI与行急诊PCI两组差异无统计学意义(χ^2=0.279,P=0.598)。结论①急诊PCI在症状距IRA开通时间≤6 h患者心肌存活性较高;②急诊静脉溶栓治疗在症状距IRA开通时间>6 h患者心肌存活性较低;③早期行补救性PCI近期对心肌存活性有积极的影响。Objective To investigate the effects of different revascularization strategies on myocardial viability in patients with acute myocardial infarction.Methods 127 patients with acute myocardial infarction treated in the hospital from January 2016 to February 2018 were selected.According to the results of 64 rows of CT,they were divided into two groups:myocardial survival group and non-survival group.The clinical characteristics and intravenous thrombolysis were compared between the two groups.Emergency PCI,remedial PCI data were compared between the two groups.Results The proportion of patients with myocardial viability group with emergency PCI opening and infarction-related coronary artery(IRA)less than 6 h from the onset of symptoms was 67.9%,and the non-viable myocardium group was 38.1%.The difference was statistically significant(χ2=8.415,P=0.004);the proportion of patients with myocardial viability group whose emergency intravenous thrombolysis is more than 6 hours from the onset of symptoms was 20.0%,and the proportion of patients without viable myocardium was 66.7%.The viable myocardium group was significantly smaller than that of the non-viable myocardium group,and the difference was statistically significant(χ2=4.791,P=0.029);there was no statistically significant difference between rescue PCI and emergency PCI in the myocardial survival group (χ2=0.279, P=0.598). Conclusion 1. The myocardial survival activity of patients with emergency PCI was higher within 6 hours from the opening time of IRA. 2. The myocardial survival activity of patients with emergency intravenous thrombolysis was lower than 6 hours from the opening time of IRA. 3. Early remedial PCI has a positive effect on myocardial survival in the near future.

关 键 词：心肌梗死 冠脉血运重建策略 存活心肌 急诊PCI 

分 类 号：R59[医药卫生—内科学]