经皮冠状动脉介入术联合曲美他嗪治疗急性心肌梗死合并射血分数保留心力衰竭患者的临床疗效  

Clinical efficacy of percutaneous coronary intervention combined with trimetazidine in the treatment of acute myocardial infarction complicated with heart failure with preserved ejection fraction

作　　者：洪景宣 郭延松[1] 陈新敬[1] 林娜[1] HONG Jingxuan;GUO Yansong;CHEN Xinjing;LIN Na(Department of Cardiovascular Medicine,Fujian Provincial Hospital,Fuzhou,Fujian,350000,China)

机构地区：[1]福建省立医院心血管内科,福建福州350000

出　　处：《当代医学》2023年第29期7-12,共6页Contemporary Medicine

基　　金：福建医科大学启航基金(2018QH1152)。

摘　　要：目的探讨经皮冠状动脉介入术(PCI)联合曲美他嗪治疗急性心肌梗死(AMI)合并射血分数保留心力衰竭(HFpEF)患者的临床疗效。方法选取2018年10月至2019年9月于福建省立医院心血管内科住院治疗的130例AMI合并HFpEF患者作为研究对象,按照随机数表法分为对照组与研究组,每组65例。对照组采取PCI治疗,研究组在对照组的基础上加用曲美他嗪治疗。比较两组实验室指标、冠脉病变程度及心肌梗死面积、心脏彩超参数、临床疗效、随访终点事件。结果两组血红蛋白(HGB)、谷丙转氨酶(ALT)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、空腹血糖(FPG)、肌酐(Cr)、肌钙蛋白I(TnI)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、N-末端脑钠肽前体(NTproBNP)比较差异均无统计学意义。两组冠脉病变程度及心肌梗死面积比较差异均无统计学意义。治疗后,研究组舒张早期最大血流速度E峰与舒张晚期最大血流速度A峰的比值(E/A)、左室射血分数(LVEF)高于治疗前,室间隔侧二尖瓣环心肌运动速度(Em)快于治疗前,左心房容积指数(LAVI)、左心室质量指数(LVMI)均小于治疗前,且研究组E/A、LVEF均高于对照组,Em快于对照组,心房减速时间(ADT)短于对照组,LAVI、LVMI均小于对照组,差异有统计学意义(P<0.05)。研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。两组因心脏原因再入院比例比较差异无统计学意义;研究组HFrEF发生率低于对照组,差异有统计学意义(P<0.05)。结论AMI合并HFpEF患者在PCI术后2~3周应用曲美他嗪能降低HFrEF发生率,改善患者心脏舒张功能及活动耐量,提高生命质量。Objective To investigate the clinical efficacy of percutaneous coronary intervention(PCI)combined with trimetazidine in the treatment of patients with acute myocardial infarction(AMI)complicated with heart failure with preserved ejection fraction(HFpEF).Methods 130 AMI patients with HFpEF who were hospitalized in the department of cardiology of Fujian Provincial Hospital from October 2018 to September 2019 were selected as the study subjects,they were divided into the control group and the study group according to the random number table method,with 65 cases in each group.The control group was treated with PCI,and the study group was treated with trimetazidine on the basis of the control group.The laboratory indexes,degree of coronary artery disease,myocardial infarction area,echocardiography parameters,clinical efficacy and follow-up endpoint events were compared between the two groups.Results There were no statistical differences in hemoglobin(HGB),alanine transaminase(ALT),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),fasting plasma glucose(FPG),creatinine(Cr),troponin I(TnI),creatine kinase(CK),creatine kinase isoenzyme(CKMB)and N-terminal brain natriuretic peptide preforms(NT-proBNP)between the two groups.There were no significant differences in the degree of coronary lesions and myocardial infarction size between the two groups.After treatment,the ratio of peak E of early diastolic blood flow velocity to peak A of late diastolic blood flow velocity(E/A)and left ventricular ejection fraction(LVEF)in the study group were higher than those before treatment,tventricular mitral ring myocardial motion velocity(Em)on the interventricular septum was faster than that before treatment,the left atrial volume index(LAVI)and left ventricular mass index(LVMI)were lower than those before treatment,and the E/A and LVEF in the study group were higher than those in the control group,Em was faster than that in the control group,atrial deceleration time(ADT)was shorter than that in the control group,LAVI

关 键 词：射血分数保留心力衰竭 急性心肌梗死 曲美他嗪 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病] R541.6[医药卫生—内科学]