直接经皮冠状动脉介入治疗联合冠脉内溶栓对急性ST段抬高型心肌梗死患者CTFC的影响  

Effects of PPCI Combined with Intracoronary Thrombolysis on CTFC in Patients with Acute ST-Segment Elevation Myocardial Infarction

作　　者：张家瑞 白文伟[1] 李颖[1] 李虎[1] 朱敏[1] 许翔 窦兴葵[1] 刘小永[1,2] Zhang Jiarui;Bai Wenwei;Li Yin(Department of Cardiovascular Medicine,The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650106,China)

机构地区：[1]昆明医科大学第二附属医院心血管内科一病区,云南昆明650106 [2]昆明医科大学,云南昆明650500

出　　处：《四川医学》2022年第7期671-676,共6页Sichuan Medical Journal

基　　金：昆明医科大学第二附属医院项目(编号:2019YK004)。

摘　　要：目的探讨直接经皮冠状动脉介入治疗(PPCI)联合冠脉内溶栓治疗对急性ST段抬高型心肌梗死(STEMI)患者冠脉血流水平的影响。方法选取2019年1月至2020年8月我院收治的STEMI患者85例,分为冠脉内溶栓组(23例)、血栓抽吸组(34例)、球囊扩张组(28例),比较三组手术后校正的TIMI帧数(CTFC)。结果PPCI后冠脉内溶栓组CTFC低于血栓抽吸组和球囊扩张组,方差分析显示组间比较差异有统计学意义(F=5.097,P=0.008),事后检验(SNK)提示冠脉内溶栓组与血栓抽吸组未在同一栏内,差异有统计学意义(P<0.05)。以CTFC为因变量,其他指标为自变量进行Pearson相关性分析提示CTFC与空腹血糖呈正相关,与舒张压、平均动脉压呈负相关,将与CTFC相关的因素进行多元回归分析显示CTFC与舒张压、空腹血糖仍呈相关性,差异有统计学意义。结论通过冠脉内溶栓、适当升高舒张压、改善血糖水平可能会降低CTFC,从而改善STEMI患者PPCI后冠脉灌注。Objective To study effects of direct percutaneous coronary intervention(PPCI)combined with intracoronary thrombolysis on coronary blood flow in patients with acute ST segment elevation myocardial infarction(STEMI).Methods From January 2019 to August 2020,85 patients with STEMI treated were divided into 3 groups:intracoronary thrombolysis group(n=23),thrombus aspiration group(n=34)and balloon dilatation group(n=28).Corrected TIMI frames(CTFC)were compared.Results CTFC of intracoronary thrombolysis group was lower than that of thrombus aspiration and balloon dilatation group after PPCI.Analysis of variance showed that there was significant difference between two groups(P<0.05).SNK test showed that intracoronary thrombolysis and thrombus aspiration group were not in the same column with statistically significant difference.Taking CTFC as dependent variable and other indexes as independent variables,Pearson correlation analysis showed that CTFC was positively correlated with fasting blood glucose,and negatively correlated with diastolic blood pressure and mean arterial pressure.Multiple regression analysis of factors related to CTFC showed that CTFC was still correlated with diastolic blood pressure and fasting blood glucose with statistically significant difference.Conclusion Intracoronary thrombolysis,appropriate increase of diastolic blood pressure and improvement of blood glucose may reduce CTFC,so that coronary perfusion after PPCI in STEMI patients could be improved.

关 键 词：急性ST段抬高型心肌梗死 冠脉内溶栓 校正心肌梗死溶栓治疗试验帧数 

分 类 号：R542.22[医药卫生—心血管疾病]