急诊PCI时直接支架术和延时支架术治疗老年ST段抬高急性心肌梗死的对比观察  

Comparison of immediate stenting and delayed stenting in emergency PCI for elderly patients with acute ST elevation myocardial infarction

作　　者：华朋铎[1] 石全宝[1] 井河江 白雪蕾 Hua Pengduo;Shi Quanbao;Jing Hejiang;Bai Xuelei(Department of Cardiovascular Medicine,Nanyang Second People’s Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第二人民医院心血管内科,南阳473000

出　　处：《中国实用医刊》2022年第21期34-37,共4页Chinese Journal of Practical Medicine

摘　　要：目的对比观察急诊经皮冠状动脉介入术(PCI)时直接支架术和延时支架术对老年ST段抬高急性心肌梗死患者的临床效果。方法抽取南阳市第二人民医院2020年9月至2021年9月收治的老年ST段抬高急性心肌梗死患者92例,按随机数字表法分为延时组与即刻组,每组46例。即刻组采用急诊PCI时直接支架术治疗,延时组采用PCI术时开通梗死相关血管后延时植入支架治疗。对比两组心血管不良事件发生率、左心室收缩末期容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、心功能、血浆脑利钠肽(BNP)、氨基末端B型利钠肽前体(NT-proBNP)水平、纽约心脏病协会(NYHA)分级及手术风险。结果术后1个月,延时组左室收缩末期内径、左心室舒张末期内径高于即刻组(P<0.05),BNP、NT-proBNP水平高于即刻组(P<0.05),NYHA分级Ⅰ~Ⅱ级者占比高于即刻组(P<0.05)。术后1个月,两组LVESVI、LVEDVI比较差异未见统计学意义(P>0.05)。延时组心力衰竭、再发心绞痛及非致死性心肌梗死心血管不良事件发生率(6.52%,3/46)低于即刻组(21.74%,10/46),P<0.05;延时组手术风险发生率(4.35%,2/46)低于即刻组(17.39%,8/46),P<0.05。结论与急诊PCI时直接支架植入术相比,开通血管后延迟支架术手术风险较低,预后较好。Objective To compare and observe the clinical effect of immediate stenting and delayed stenting in emergency percutaneous coronary intervention(PCI)on elderly patients with acute ST elevation myocardial infarction.Methods A total of 92 elderly patients with acute ST elevation myocardial infarction treated in Nanyang Second People’s Hospital from September 2020 to September 2021 were selected,and they were divided into delayed group and immediate group according to random number table method,with 46 cases in each group.The immediate group was treated by immediate stenting during emergency PCI,and the delayed group was treated by delayed steting after opening the infarct-related blood vessels during PCI.The incidence of cardiovascular adverse events,left ventricular end systolic volume index(LVESVI),left ventricular end diastolic volume index(LVEDVI),cardiac function,levels of brain natriuretic peptide(BNP)and N-terminal pro-B-type natriuretic peptide(NT-BNP),New York Heart Association(NYHA)classification and risk of operation were compared between the two groups.Results One month after operation,the left ventricular end systolic diameter and left ventricular end diastolic diameter in the delayed group were higher than those in the immediate group(P<0.05),the levels of BNP and NT-proBNP in the delayed group were higher than those in the immediate group(P<0.05),and the proportion of NYHA gradesⅠ-Ⅱin the delayed group was higher than that in the immediate group(P<0.05).One month after operation,there was no significant difference in LVESVI and LVEDVI between the two groups(P>0.05).The incidence of adverse cardiovascular events of heart failure,recurrent angina and nonfatal myocardial infarction in the delayed group(6.52%,3/46)was lower than that in the immediate group(21.74%,10/46),P<0.05.The incidence of operation risk in the delayed group(4.35%,2/46)was lower than that in the immediate group(17.39%,8/46),P<0.05.Conclusions Compared with immediate stenting during emergency PCI,delayed stenting after vascular o

关 键 词：ST段抬高心肌梗死 老年 经皮冠状动脉介入术 直接支架术 延时支架术 

分 类 号：R542.22[医药卫生—心血管疾病]