PCI联合主动脉内球囊反搏治疗老年急性心肌梗死合并心力衰竭的临床研究  

Clinical Study of PCI Combined with Intra-aortic Balloon Counterpulsation for the Treatment of Elderly Patients with Acute Myocardial Infarction Complicated with Heart Failure

作　　者：余媛媛[1] 廖延标 韦先林 余情瑶 王佳琳[1] 徐英[1] YU Yuanyuan;LIAO Yanbiao;WEI Xianlin;YU Qingyao;WANG Jialin;XU Ying(West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院,成都610041

出　　处：《中西医结合心脑血管病杂志》2024年第11期2000-2004,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金资助项目(No.81900348)。

摘　　要：目的:探讨老年急性心肌梗死(AMI)合并心力衰竭病人采用经皮冠状动脉介入术(PCI)联合主动脉内球囊反搏(IABP)治疗的临床效果。方法:回顾性选取2018年9月—2020年9月四川大学华西医院收治的老年AMI合并心力衰竭病人103例,其中采用IABP联合PCI治疗的52例病人作为联合组,另选取同期收治的仅采用PCI治疗的51例病人作为对照组。比较两组治疗后心肌梗死溶栓试验(TIMI)血流分级、心肌酶学指标、心功能指标、不良心血管事件(MACE)发生率。结果:治疗后,联合组靶血管TIMI血流分级优于对照组(P<0.05)。治疗后,两组血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肌钙蛋白T(cTnT)水平均较治疗前明显降低(P<0.05),但两组治疗后各指标比较差异无统计学意义(P>0.05)。治疗后,联合组左室射血分数(LVEF)高于对照组,左室收缩末期内径(LVESD)、氨基末端脑钠肽前体(NT-proBNP)低于对照组,差异均有统计学意义(P<0.05)。随访24个月,联合组MACE发生率为5.77%,低于对照组的21.57%,差异有统计学意义(P<0.05)。结论:采用IABP联合PCI治疗AMI合并心力衰竭的老年病人,可促进心功能恢复、靶血管血流恢复,降低MACE发生率。Objective:To explore the clinical effect of percutaneous coronary intervention(PCI)combined with intra-aortic balloon counterpulsation(IABP)for elderly patients with acute myocardial infarction(AMI)complicated with heart failure.Methods:A total of 103 elderly patients with AMI complicated with heart failure were retrospectively selected,including 52 patients treated with IABP combined with PCI as the combination group,and 51 patients treated with PCI only during the same period as the control group.The TIMI blood flow grade,myocardial enzymologic index,cardiac function index,and incidence of adverse cardiovascular events(MACE)were compared between the two groups after treatment.Results:After treatment,the TIMI blood flow grading of target vessel in combination group was better than that in the control group(P<0.05).After treatment,serum levels of creatine kinase isoenzyme(CK-MB),troponin I(cTnI),lactate dehydrogenase(LDH),and troponin T(cTnT)in two groups decreased compared with those before treatment(P<0.05),but there were no statistical significance between the two groups after treatment(P>0.05).After treatment,the left ventricular ejection fraction(LVEF)of combination group was higher than that of the control group,but the left ventricular end-systolic diameter(LVESD)and the N-terminal pro-B-type natriuretic peptide(NT-proBNP)of combination group were lower than that of the control group,with statistical significance(P<0.05).After 24 months of follow-up,the incidence of MACE in combination group was 5.77%,lower than that 21.57%in the control group,and the difference was statistically significant(P<0.05).Conclusion:IABP combined with PCI for the treatment of elderly patients with AMI complicated with heart failure can promote the recovery of cardiac function and target blood flow,and reduce the incidence of MACE.

关 键 词：急性心肌梗死 心力衰竭 老年人 经皮冠状动脉介入术 主动脉内球囊反搏 不良心血管事件 

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