1期支架植入和延期支架植入对高血栓负荷急性心肌梗死患者QTc离散度与心肌灌注的影响  

Influences of phase 1 stent implantation and delayed stent implantation on QTc dispersion and myocardial perfusion in acute myocardial infarction patients with a high thrombus burden

作　　者：郑晓 陈雪 杨枫 张楠 苏艳 ZHENG Xiao;CHEN Xue;YANG Feng(The NO.2 Hospital of Baoding,Hebei,Baoding 071000,China)

机构地区：[1]河北省保定市第二医院,071000

出　　处：《河北医药》2023年第6期833-836,共4页Hebei Medical Journal

基　　金：保定市科学技术研究与发展计划项目(编号:2141ZF013)。

摘　　要：目的 探讨1期支架植入和延期支架植入对高血栓负荷急性心肌梗死患者QTc离散度与心肌灌注的影响。方法 选取经冠脉造影显示为高血栓负荷急性心肌梗死(AMI)的80例患者为研究对象,根据血管开通后是否即刻进行支架植入分为1期支架植入组和延期支架植入组,每组40例,同时选取同期入院检查的40例胸痛、胸闷但冠状造影正常者为对照组。观察并记录患者一般情况,比较3组患者术前及术后QTc离散度、心肌灌注情况(TIMI血流分级、血栓评分)、PCI情况以及术后主要不良心血管事件(MACE)发生率。结果 无论是1期支架植入组还是延期支架植入组,术后均显著降低了AMI患者的QTc离散度,提高了TIMI3级血流占比,降低了血栓积分,且以延迟组改善效果更明显(P<0.05);延迟组无论是在置入支架例数、平均支架数量,还是支架直径、支架长度方面,均显著低于1期支架植入组,差异具有统计学意义(P<0.05);院内及术后1年内延迟组的MACE发生率远低于1期组(P<0.05)。结论 AMI患者血管开通后延迟支架的植入利于患者QTc离散度的降低、心肌灌注情况的改善,且可达到较好的预后效果,效果优于1期支架植入。Objective To explore the influences of phase 1 stent implantation and delayed stent implantation on QTc dispersion and myocardial perfusion in acute myocardial infarction(AMI)patients with a high thrombus burden.Methods A total of 80 AMI patients with a high thrombus burden confirmed by coronary angiography were retrospectively recruited.They were assigned to phase 1 stent implantation group and delayed stent implantation group according to the immediately stent implantation after vasodilation or not,with 40 in each group.40 patients with chest pain,and chest tightness but normal coronary angiographic findings during the same period were recruited in the control group.Clinical data were recorded.Preoperative and postoperative QTc dispersion,myocardial perfusion(TIMI blood flow grading,thrombosis score),percutaneous coronary intervention(PCI),and the incidence of major postoperative adverse cardiovascular events(MACE)were compared between groups.Results Both phase 1 stent implantation and delayed stent implantation significantly reduced postoperative QTc dispersion and thrombosis scores of AMI patients,and increased the ratio of TIMI3 blood flow,which were more pronounced in delayed stent implantation group(all P<0.05).The number of placed stents,mean number of stents,stent diameter and length in delayed stent implantation group were significantly lower than those of phase 1 stent implantation group(P<0.05).The incidence of MACE during hospitalization and 1 year postoperatively was significantly lower in delayed stent implantation group than that of phase 1 stent implantation group(P<0.05).Conclusion Delayed stent implantation after vascular opening in AMI patients is beneficial to the reduction of QTc dispersion and the improvement of myocardial perfusion,which can achieve a better prognosis effect than that of phase 1 stent implantation.

关 键 词：极性心肌梗死 QTC离散度 心肌灌注 

分 类 号：R542.22[医药卫生—心血管疾病]