急性ST段抬高心肌梗死患者早期再灌注策略的选择及预后分析  

Early reperfusion strategy selection and prognosis analysis in patients with acute ST segment elevation myocardial infarction:based on the data of 49 hospitals in Hebei Province

作　　者：彭楠 肖浩[1] 董艳玲 孟庆冰[1] 郑拓康 崔晓磊[1] 姚冬奇[1] 田英平[1] 高恒波[1] Peng Nan;Xiao Hao;Dong Yanling;Meng Qingbing;Zheng Tuokang;Cui Xiaolei;Yao Dongqi;Tian Yingping;Gao Hengbo(Department of Emergency,Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北医科大学第二医院急诊科,石家庄050000

出　　处：《中华危重病急救医学》2021年第5期578-581,共4页Chinese Critical Care Medicine

基　　金：河北省政府资助临床医学优秀人才培养和基础课题研究项目(2017-46)。

摘　　要：目的探讨急性ST段抬高心肌梗死(STEMI)患者早期再灌注治疗的策略选择及对预后的影响。方法收集河北省49家医院在2016年1月至12月经急诊就诊的急性心肌梗死(AMI)患者的救治资料及3年随访结局。入选发病12 h内经静脉溶栓治疗(ITT)或直接经皮冠状动脉介入治疗(PPCI)的STEMI患者。对比ITT组与PPCI组患者的一般资料、首诊至再灌注开始时间(ITT患者记为FMC2N,PPCI患者记为FMC2B)、血管再通率、住院病死率、1年病死率及3年病死率;并分析不同再灌注开始时间(FMC2N≤30 min、FMC2N>30 min、FMC2B≤120 min、FMC2B>120 min)ITT与PPCI的疗效及预后。结果最终选择1371例经ITT或PPCI治疗的STEMI患者,其中ITT组300例,PPCI组1071例;实际随访1055例(ITT组205例,PPCI组850例),随访率为79.4%。两组患者在年龄、性别、既往史等方面比较差异均无统计学意义。ITT组首诊至再灌注开始时间短于PPCI组〔min:63(38,95)比95(60,150),U=-9.286,P=0.000〕,但均明显长于指南标准时间。与ITT组相比,PPCI组血管再通率较高〔95.5%(1023/1071)比88.3%(265/300),P<0.01〕,住院病死率较低〔2.1%(22/1071)比6.7%(20/300),P<0.01〕,而1年病死率及3年病死率差异均无统计学意义〔5.3%(45/850)比4.4%(9/205),9.5%(81/850)比9.3%(19/205),均P>0.05〕。在不同再灌注开始时间ITT组和PPCI组中,FMC2N>30 min组血管再通率最低,住院病死率最高。两两比较显示,FMC2B≤120 min组、FMC2B>120 min组血管再通率显著高于FMC2N>30 min组〔95.5%(654/685)、95.6%(369/386)比88.0%(220/250),均P<0.008〕,住院病死率显著低于FMC2N>30 min组〔2.0%(14/685)、2.1%(8/386)比7.6%(19/250),均P<0.008〕,而4组间1年病死率(χ^(2)=2.507、P=0.443)及3年病死率(χ^(2)=2.204、P=0.522)差异均无统计学意义。结论对于发病12 h内的STEMI患者应及早行再灌注治疗;与ITT相比,PPCI梗死动脉开通率高,住院病死率低,对1年、3年病死率无影响。Objective To explore the selection of strategies for early reperfusion therapy and its impact on prognosis in patients with acute ST segment elevation myocardial infarction(STEMI).Methods The treatment data and 3-year follow-up results of acute myocardial infarction(AMI)patients in 49 hospitals in Hebei Province from January to December 2016 were collected.Patients with STEMI who received either intravenous thrombolytic therapy(ITT)or primary percutaneous coronary intervention(PPCI)within 12 hours of onset were enrolled.Baseline data,the time from the first diagnosis to the start of reperfusion(FMC2N for ITT patients and FMC2B for PPCI patients),vascular recanalization rate,in-hospital mortality,1-year mortality,and 3-year mortality were compared between ITT and PPCI groups.The efficacy and prognosis of ITT and PPCI at different starting time of reperfusion(FMC2N≤30 minutes,FMC2N>30 minutes,FMC2B≤120 minutes,FMC2B>120 minutes)were analyzed.Results A total of 1371 STEMI patients treated with ITT or PPCI were selected,including 300 patients in the ITT group and 1071 patients in the PPCI group.1055 patients were actually followed up(205 patients in the ITT group and 850 patients in the PPCI group),with a rate of 79.4%.There were no significant differences in age,gender,and previous history between the two groups.The time from the first diagnosis to the start of reperfusion in the ITT group was shorter than that in the PPCI group[minutes:63(38,95)vs.95(60,150),U=-9.286,P=0.000],but was significantly longer than the guideline standard.Compared with the ITT group,the vascular recanalization rate in the PPCI group was higher[95.5%(1023/1071)vs.88.3%(265/300),P<0.01],and in-hospital mortality was lower[2.1%(22/1071)vs.6.7%(20/300),P<0.01],but there were no significant differences in the 1-year mortality and 3-year mortality[5.3%(45/850)vs.4.4%(9/205),9.5%(81/850)vs.9.3%(19/205),both P>0.05].Between ITT group and PPCI group with different reperfusion starting time,the FMC2N>30 minutes group had the lowest vascular rec

关 键 词：ST段抬高心肌梗死 直接经皮冠状动脉介入治疗 静脉溶栓治疗 再灌注开始时间 

分 类 号：R542.22[医药卫生—心血管疾病]