不同时机经皮冠状动脉介入治疗急性心肌梗死临床疗效及对心功能、心肌受损指标的影响  

Clinical Efficacy of Percutaneous Coronary Interventio in Treatment of Patients with Acute Myocardial Infarction during Different Times and Its Effects on Cardiac Function and Myocardial Damage Indexes

作　　者：张胜[1] 张全慧[1] 康忠俊 ZHANG Sheng;ZHANG Quan-hui;KANG Zhong-jun(Department of Cardiology,the First People's Hospital of Ziyang,Ziyang,Sichuan 641300,China)

机构地区：[1]资阳市第一人民医院心内科,四川资阳641300

出　　处：《解放军医药杂志》2021年第4期49-53,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省科技计划项目(2017SZ0261)。

摘　　要：目的经皮冠状动脉介入手术(PCI)急诊或择期治疗对急性心肌梗死患者临床疗效、心功能及心肌受损指标的影响。方法回顾性分析2017年8月—2019年7月我院收治的80例急性心肌梗死患者的临床资料,根据手术时间不同分为观察组和对照组,每组40例。观察组进行急诊PCI(发病至就诊时间12~24 h),对照组进行择期PCI(发病至就诊时间>24 h)。对比2组的临床疗效,治疗前及治疗后1个月心功能及心肌受损指标水平变化情况。结果2组治疗后总有效率比较差异无统计学意义(P>0.05)。与治疗前比较,2组治疗后左心室收缩末容积、左心室舒张末期容积增高,左心室射血分数减低,且观察组变化较对照组更显著(P<0.05)。2组治疗后B型脑钠肽、肌钙蛋白T、肌酸激酶同工酶均降低,且观察组低于对照组(P<0.05)。观察组出院后6个月内心血管意外事件总发生率显著低于对照组(P<0.05)。结论择期PCI治疗与急诊PCI治疗急性心肌梗死临床疗效相当,发病至PCI间隔12~24 h进行急诊PCI,有利于改善患者的心功能及预后。Objective To analyze effects of percutaneous coronary intervention(PCI)by emergency or elective treatment on clinical efficacy,cardiac function and myocardial damage indexes in patients with acute myocardial infarction.Methods Clinical data of 80 patients with acute myocardial infarction admitted during August 2017 and July 2019 was retrospectively analyzed,and they were divided into observation group(n=40)and control group(n=40)according to differences of operative time.Observation group was given emergency PCI(12-24h from attack to visit),while control group was given elective PCI(larger than 24h from attack to visit).Clinical efficacy,changes of indexes of cardiac function and myocardial damage before and in 1 month after treatment were compared between two groups.Results There was no statistically significant difference in the total effective rate between two groups after treatment(P>0.05).Compared with those before treatment,values of left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)were significantly increased,while left ventricular ejection fraction(LVEF)levels were significantly decreased after treatment in two groups,and the changes in observation group were more obvious than those in control group(P<0.05).After treatment,levels of B-type natriuretic peptide(BNP),cardiac troponin(cTnT)and creatine kinase isoenzymes(CK-MB)were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05).The total incidence rate of cardiovascular accidents within 6 months after discharge in observation group was significantly lower than that in control group(P<0.05).Conclusion Elective PCI surgery may achieve similar clinical efficacy with that by emergency PCI surgery in treatment of patients with acute myocardial infarction.Emergency PCI surgery(within 12-24h from attack to PCI)is beneficial to improve cardiac function and prognosis of patients.

关 键 词：心肌梗死 经皮冠状动脉介入 每搏输出量 利钠肽 脑 肌钙蛋白T 

分 类 号：R542.22[医药卫生—心血管疾病]