急诊PCI与延迟PCI对急性非ST段抬高型心肌梗死患者的临床疗效对比研究及其心功能的影响  

Comparative study of clinical efficacy and cardiac function of emergency PCI and delayed PCI in patients with acute non-ST segment elevation myocardial infarction

作　　者：邹华伟 周金锋 赵勇 焦莉莉 ZOU Hua-wei;ZHOU Jin-feng;ZHAO Yong(Department of Cardiovascular Medicine,,Fuyang Anhui 236000,China;Department of Emergency,Fuyang Hospital of AnHui Medical University,Fuyang Anhui 236000,China)

机构地区：[1]安徽医科大学附属阜阳医院心血管内科,安徽阜阳236000 [2]安徽医科大学附属阜阳医院急诊科,安徽阜阳236000

出　　处：《临床和实验医学杂志》2021年第16期1692-1696,共5页Journal of Clinical and Experimental Medicine

基　　金：2014年安徽高校省级自然科学研究项目(编号:KJ2014A122)。

摘　　要：目的比较延迟经皮冠脉介入(DPCI)与急诊直接PCI(PPCI)治疗急性非ST段抬高型心肌梗死(NSTEMI)的临床疗效及对心功能的影响。方法回顾性将2017年8月至2020年9月安徽医科大学附属阜阳医院心血管内科和急诊科收治的102例NSTEMI患者纳入研究,按照治疗方法不同将其分为PPCI组(n=51)和DPCI组(n=51)。PPCI组患者行冠脉造影(CAG)后即刻行直接PCI治疗,DPCI组患者行CAG后,经约1周药物治疗后,再行DPCI治疗。比较DPCI组和PPCI组术后1个月的临床疗效,比较术前和术后1个月后的心功能指标[左室收缩末期内径(LVED)、左室舒张末期内径(LVDD)、左心室射血分数(LVEF)]和血浆脑利钠肽(BNP)、氨基末端B型利钠肽前体(NT-pro BNP)的浓度变化,术后3个月的纽约心脏病协会(NYHA)心功能分级改善情况以及术后6个月的心血管不良事件(MACE)发生率。结果 DPCI组的总有效率(96.08%)高于PPCI组(80.39%),差异有统计学意义(P<0.05)。DPCI组术后1个月的LVED和LVDD为(44.25±2.15)、(40.30±1.50) mm,均显著低于PPCI组[(46.70±2.25)、(44.50±1.75) mm],而LVEF指标为(47.35±2.85)%,显著高于PPCI组[(42.15±2.40)%],差异均有统计学意义(P<0.05)。DPCI组术后1个月的血浆BNP、NT-pro BNP水平为(161.29±68.47) pg/mL、(284.26±64.12) ng/L,均显著低于PPCI组[(334.61±75.32) pg/mL、(372.51±66.30) ng/L],差异均有统计学意义(P<0.05)。DPCI组术后1个月NYHA心功能分级改善显著优于PPCI组,差异有统计学意义(P<0.05)。术后6个月,DPCI组的MACCE发生率(7.84%)显著低于对照组低(23.53%),差异有统计学意义(P<0.05)。结论延迟PCI治疗NSTEMI患者相比PPCI治疗的疗效更好,可显著改善心功能,降低术后MACE的发生。Objective To compare the clinical efficacy and cardiac function of delayed percutaneous coronary intervention(DPCI) and emergency direct PCI(PPCI) in the treatment of acute non-ST segment elevation myocardial infarction(NSTEMI). Methods It was a retrospective study. From August 2017 to September 2020,102 patients with NSTEMI admitted to the Department of Cardiovascular Medicine and Department of Emergency,Fuyang Hospital of An Hui Medical Universityl were divided into two groups: PPCI group(n = 51) and DPCI group(n = 51)according to different treatment methods. The patients in the PPCI group were treated with direct PCI immediately after coronary angiography(CAG),and the patients in the DPCI group were treated with DPCI after about 1 week of drug treatment after CAG. The clinical effects of DPCI group and PPCI group were compared one month after operation,and the changes of cardiac function indexes [left ventricular end-systolic diameter(LVED),left ventricular end-diastolic diameter(LVDD),left ventricular ejection fraction(LVEF) ],plasma brain natriuretic peptide(BNP),N-terminal B-type natriuretic peptide precursor(NT-proBNP) concentration before and 1 month after operation and the improvement of NYHA cardiac function grade 3 months after operation were compared,as well as the incidence of cardiovascular adverse events(MACCE) 6 months after operation. Results The total effective rate of the DPCI group(96. 09%) was higher than that of the PPCI group(80. 39%),and the difference was statistically significant(P<0.05). The LVED and LVDD of the DPCI group 1 month after surgery were(44. 25 ± 2. 15) and(40. 30 ± 1. 50) mm,which were significantly lower than those of the PPCI group [(46. 70 ± 2. 25),(44. 50 ± 1. 75) mm],while LVEF was(47. 35 ± 2. 85) %,which was significantly higher than the PPCI group [(42. 15 ±2. 40) % ],and the differences were statistically significant(P< 0. 05). The levels of plasma BNP and NT-pro BNP in the DPCI group 1 month after surgery were(161. 29 ± 68. 47) pg/mL and(284. 26 ±64. 12) ng

关 键 词：急性非ST段抬高型心肌梗死 延迟PCI 急诊PCI 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]