急性心肌梗死静脉溶栓联合PCI治疗的临床效果  

Clinical effect of Intravenous thrombolysis combined with PCI on treatment of patients with acute myocardial infarction

作　　者：龙涛[1] 周名纲[2] 曾志诚 刘忍 邓茂 倪秋萍 干静 LONG Tao;ZHOU Ming-gang;ZENG Zhi-cheng;LIU Ren;DENG Mao;NI Qiu-ping;GAN Jing(Lezhi County People′s Hospital,Ziyang,Sichuan 641500,China)

机构地区：[1]乐至县人民医院心血管内科,四川资阳641500 [2]成都市第三人民医院心血管内科,四川成都610031

出　　处：《中华医院感染学杂志》2021年第9期1353-1357,共5页Chinese Journal of Nosocomiology

基　　金：资阳市科学技术局资阳市财政局基金资助项目(Zykjjsc20-yyjc-2019-15)。

摘　　要：目的探究急性心肌梗死静脉溶栓联合冠状动脉介入手术(PCI)治疗与直接PCI治疗对患者血管性血友病因子(vWF)、一氧化氮(NO)、P选择素(PS)及不良事件的影响。方法选取2019年1-12月乐至县人民医院心血管内科接受诊治的49例急性心肌梗死患者作为研究对象,根据随机数字表法分为研究组(24例)和对照组(25例)。对照组立刻给予PCI治疗,研究组予以静脉溶栓后择期PCI治疗。比较两组术后临床疗效和手术前后血生化相关因子、心功能变化,观察不良事件发生情况。结果术后3 d,研究组ST段下移率、血管梗死再通率、支架置入成功率、胸痛缓解率均高于对照组(P<0.05);术后3 d,两组血浆NO水平较术前均升高,且研究组高于对照组(P<0.05),血清vWF、PS、NT-proBNP水平均较术前降低,且研究组低于对照组(P<0.05);两组患者左心室射血分数(LVEF)均较术前升高,且研究组高于对照组(P<0.05),左心室舒张末期内径(LVEDD)、左心室收缩末内径(LVESD)均较术前降低,且研究组低于对照组(P<0.05);研究组患者发生1例急性左心衰竭,心脏不良事件总发生率为4.17%(1/24),对照组患者发生心源性死亡2例、急性左心衰竭2例、再梗发生4例,心脏不良事件总发生率为32.00%(8/25)。结论早期静脉溶栓联合PCI治疗对急性心梗患者梗死血管疏通效果更佳,可通过提高NO水平,降低vWF、PS水平,从而有效抑制血小板凝集,改善患者心功能,降低NT-proBNP水平,且术后发生心脏不良事件的概率较低,值得临床进一步研究后应用。OBJECTIVE To explore the clinical effects of intravenous thrombolysis combined with percutaneous coronary intervention(PCI)and direct PCI on von Willebrand factor(vWF),nitric oxide(NO)and P-selectin(PS)as well as adverse events in the patients with acute myocardial infarction.METHODS A total of 49 patients with acute myocardial infarction who were treated in department of cardiovascular medicine department of Lezhi County People′s Hospital from Jan.2019 to Dec.2019 were recruited as the study subjects and randomly divided into the study group with 24 cases and the control group with 25 cases.The control group was instantly given the PCI,while the study group was given PCI at a selecting time after intravenous thrombolysis.The clinical curative effects,biochemical indexes and cardiac function indexes were compared between the two groups,and the incidence of adverse events was observed.RESULTS The depression rate of ST segment,recanalization rate of vascular infarction,success rate of stent implantation and relief rate of chest pain were significantly higher in the study group than in the control group after the surgery for 3 days(P<0.05);the plasma NO level of both groups was significantly higher after the surgery for 3 days than before the surgery,and the plasma NO level of the study group was significantly higher than that of the control group(P<0.05);the levels of serum vWF,PS and NT-proBNP of both group were significantly lower after the surgery for 3 days than before the surgery,and the levels of above indexes of the study group were significantly lower than those of the control group(P<0.05).The left ventricular ejection fraction(LVEF)of the two groups of patients was significantly higher after the surgery for 3 days than before the surgery,and the LVEF of the study group was significantly higher than that of the control group(P<0.05);the left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)of both groups were significantly lower after the surgery for 3 days than b

关 键 词：急性心肌梗死 静脉溶栓 冠状动脉介入手术 心功能 术后感染 P选择素 

分 类 号：R541[医药卫生—心血管疾病]