肝素早期预处理对急诊介入治疗STEMI患者梗死相关血管血流及对炎性因子和远期心功能影响  

Early heparin preconditioning on infarction related vascular blood flow and inflammatory factors and long term cardiac function in STEMI patients undergoingg emergency interventional therapy

作　　者：肖立运 李秀丽 许胜 XIAO Liyun;LI Xiuli;XU Sheng(Department of Emergency Medicine,Jining First People's Hospital,Jining,Shandong,272000,China;Department of Emergency Medicine,Jining North Lake Provincial Tourism Resort People's Hospital)

机构地区：[1]济宁市第一人民医院急诊科,山东济宁272000 [2]济宁北湖省级旅游度假区人民医院急诊科

出　　处：《临床急诊杂志》2023年第10期516-522,共7页Journal of Clinical Emergency

基　　金：济宁市重点研发基金资助项目(No:2019MNS021,2022YXNS131)。

摘　　要：目的:探讨肝素早期预处理对急诊介入治疗急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction, STEMI)患者的梗死相关血管(infarct related artery, IRA)血流及对炎性因子、远期心功能的影响。方法:选取济宁市第一人民医院急诊科2020年1月-2022年2月收治的STEMI患者58例,男38例,女20例;年龄41~72岁,平均(55.6±13.8)岁。所选择患者按照Doll’s临床病例随机分成两组:常规治疗组,即A组(29例);早期肝素预处理组,即B组(29例)。两组患者均为单绕途径,即绕行CCU,直接通过急诊至导管室,并实施了急诊直接经皮冠状动脉介入术(primary percutaneous coronary intervention, PPCI),A组为急诊科嚼服双抗血小板药物,完善心肌坏死标记物及炎性因子检测:肌钙蛋白I(cTnI)、肌红蛋白(myoglobin, Myo)、肌酸激酶同工酶(creatine kinase isoenzyme, CK-MB)等及超敏C反应蛋白(C-reactive protein, CRP)后至导管室直接实施急诊PCI,术后继续常规治疗。B组在A组基础上,急诊科用普通肝素预处理(剂量100 U/kg+生理盐水5 mL静脉推注)后直达导管室。两组患者均观察治疗前后IRA造影剂显示情况,即冠脉远端血流(thrombolysis in myocardial infarction, TIMI)分级和评价再灌注情况;术后即测定心电图与急诊科心电图对比,观察ST段回落情况。术后2 h测定cTnI、CK-MB、Mb、CRP。两组出院1个月、3个月、6个月的心脏超声测定左室射血分数(left ventricular ejection fraction, LVEF)、左室收缩末期容积(left ventricular end systolic volume, LVESV)、左室舒张末期容积(left ventricular end diastolic volume, LVEDV)指标。记录住院期间及术后半年内出血事件及主要不良心血管事件(major adverse cardiovascular events, MACE)。结果:与A组比较,B组治疗前IRA再通比例高,两组差异有统计学意义(P<0.05);与A组比较,B组术后慢血流、无复流比例减少,TIMI 3级慢、快血流比例增加,差异有统计学意义(P<0.05)。与A�Objective:To investigate the effects of early heparin pretreatment on infarct related artery(IRA)blood flow,inflammatory factors,and long-term cardiac function in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing emergency intervention treatment.Methods:Fifty-eight STEMI patients,including 38 males and 20 females,aged 41-72,with mean(55.6±13.8)years,admitted to the emergency department of our hospital from January 2020 to February 2022,were selected.The selected patients were randomly divided into a conventional group based on Doll's clinical cases,namely Group A(29 cases)and an early heparin pretreatment group,namely Group B(29 cases).The two selected groups of patients underwent a single bypass pathway,which involves bypassing the CCU and directly entering the catheterization room through the emergency department and emergency direct percutaneous coronary intervention(PPCI)was performed.Group A received dual antiplatelet drugs and improved detection of myocardial necrosis markers and inflammatory factors,including troponin I(cTnI),myoglobin(Myo),creatine kinase isoenzyme(CK-MB),and high sensitivity C-reactive protein(CRP),etc.Emergency PCI was directly performed in the catheter room,and routine treatment continued after the surgery.On the basis of Group A,Group B was pretreated with ordinary heparin(dosage of 1oo U/kg+5 mL of physiological saline intravenously)in the emergency department and then directed to the catheter room.Both groups of patients were observed for the display of IRA contrast agent before and after treatment,including the classification of distal coronary artery flow(TIMI)and evaluation of reperfusion status.After the surgery,the electrocardiogram was measured and compared with the electrocardiogram of the emergency department to observe the ST segment regression.CTnI,CK-MB,Mb,CRP were measured 2 hours after surgery.Left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),and left ventricular end diastolic volume(LVEDV)were measured b

关 键 词：预处理 急性ST段抬高型心肌梗死 经皮冠状动脉介入术 梗死相关动脉 

分 类 号：R542.22[医药卫生—心血管疾病]