院前静脉溶栓对STEMI患者微循环血流灌注及短期预后的疗效观察  

Effect of pre-hospital intravenous thrombolysis on microcirculation perfusion and short-term prognosis in patients with ST-elevation myocardial infarction

作　　者：安群英 孟祥会 潘吉亚 孙国宁 张敬 AN Qunying;MENG Xianghui;PAN Jiya(Department of Science and Education,the Sixth People’s Hospital of Hengshui,Hebei,Hengshui 053200,China)

机构地区：[1]河北省衡水市第六人民医院,053200

出　　处：《河北医药》2024年第13期1950-1954,共5页Hebei Medical Journal

基　　金：衡水市科技计划项目(编号:2023014058Z)。

摘　　要：目的 院前静脉溶栓对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)术中微循环血流灌注及短期预后的疗效。方法 收集2022年6月至2023年6月收治的STEMI患者,根据再灌注策略,将患者分为院前静脉溶栓后PCI组(58例,A组)和急诊转运PCI组(58例,B组)。比较2组介入术中情况、重要部位出血情况及主要不良心脑血管事件(MACCE)。结果 A组较B组再灌注时间明显缩短,术前TIMI血流分级≥2级比例增多,置入支架数量下降,术后无复流/慢血流发生率减少;术后7、30、90d复查心脏超声,A组左心室舒张末内径及WMSI下降,A组30、90 d LVEF升高(P<0.05);2组患者主要出血事件及MACCE发生率差异无统计学意义(P>0.05)。结论 患者给予院前静脉溶栓能够缩短心肌缺血再灌注时间,减少术中微循环灌注障碍发生率,但主要出血事件和MACCE未增加。Objective To evaluate the therapeutic effect of pre-hospital intravenous thrombolysis on microcirculation perfusion and short-term prognosis in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods STEMI patients admitted from June 2022 to June 2023 were randomly assigned into group A(pre-hospital intravenous thrombolysis,n=58)and group B(PCI after emergency transfer,n=58)according to the reperfusion strategy.Intraoperative conditions,important site bleeding,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the two groups.Results Compared with those of group B,patients in group A presented significantly shorter reperfusion time,more number of patients with preoperative Thrombolysis in Myocardial Infarction(TIMI)of grade 2 and above,less number of stent implants,and lower incidence of non-reperfusion/slow blood flow(P<0.05).On the 7th,30th,and 90th day after surgery,follow-up echocardiography showed significantly increased left ventricular ejection fraction(LVEF)and decreased left ventricular end-diastolic diameter(LVEDD)and wall motion score index(WMSI)(P<0.05).There were no significant difference in the incidence of major bleeding events and MACCEs between the two groups(P>0.05).Conclusion Pre-hospital intravenous thrombolysis effectively shortens the time of myocardial ischemia-reperfusion and reduces the incidence of intraoperative microcirculation perfusion disorders,without increasing the risk of main bleeding events and MACCEs.

关 键 词：ST段抬高型心肌梗死 院前静脉溶栓 经皮冠状动脉介入术 无复流 

分 类 号：R459.7[医药卫生—急诊医学]