提前肝素化对急诊PCI的STEMI患者心功能恢复、心肌灌注及MACE的影响  

The effects of early heparinization on cardiac function recovery,myocardial perfusion,and MACE in STEMI patients undergoing emergency PCI

作　　者：王慧 时秀文 吕晓翠 李静 赵韩婷 治雅倩 李新军[1] 程光慧 WANG Hui;SHI Xiuwen;LV Xiaocui;LI Jing;ZHAO Hanting;ZHI Yaqian;LI Xinjun;CHENG Guanghui(Department of Cardiology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei,China)

机构地区：[1]河北北方学院附属第二医院心内科,河北张家口075100

出　　处：《中南医学科学杂志》2025年第1期118-121,共4页Medical Science Journal of Central South China

基　　金：河北省卫生和计划生育委员会科研基金项目(20242060)。

摘　　要：目的观察提前肝素化对急诊经皮冠状动脉介入术(PCI)的急性ST段抬高型心肌梗死(STEMI)患者心功能恢复、心肌灌注及不良心血管事件(MACE)的影响。方法选取急诊PCI治疗的96例STEMI患者为研究对象,根据肝素应用时机,将其分为提前组(提前肝素化)40例及常规组56例。比较两组手术前后心功能指标[左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左心室心肌质量指数(LVMI)、氨基末端脑钠肽前体(NT-proBNP)]及术后即刻心肌血流灌注情况[心肌梗死溶栓试验(TIMI)血流分级及冠状动脉左前降支(LAD)、右冠状动脉(RCA)的TIMI校正帧数];记录两组术后3个月内MACE发生情况。结果两组术后LVEF较术前升高,且提前组高于常规组(P<0.05);LVEDD、LVMI、NT-proBNP较术前降低,且提前组低于常规组(P<0.05)。术后即刻,提前组患者TIMI血流3级占比高于常规组,1级、2级占比低于常规组(P<0.05),LAD、RCA的TIMI校正帧数均低于常规组(P<0.05)。两组患者术后3个月MACE发生率间差异无统计学意义(P>0.05)。结论提前肝素化有利于促进急诊PCI的STEMI患者心功能恢复、提高其心肌灌注水平,且不增加MACE发生风险。Aim To investigate the effects of early heparinization on cardiac function recovery,myocardial perfusion,and major adverse cardiovascular events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods 96 patients with STEMI who underwent emergency PCI were selected as the study subjects.According to the treatment time of heparin,40 cases were divided into the early group(early heparinization)and 56 cases were divided into the conventional group.Cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular mass index(LVMI),N-terminal pro-brain natriuretic peptide(NT-proBNP)]before and after surgery and immediate myocardial blood flow perfusion after surgery[thrombolysis in myocardial infarction(TIMI)blood flow grading and TIMI corrected frame rate of left anterior descending(LAD),right coronary artery(RCA)]were compared between the two groups.The occurrence of MACE in the two groups within 3 months after surgery were recorded.Results The postoperative LVEF levels of both groups were increased compared with preoperative levels,and they were higher in the early group compared with the conventional group(P<0.05).LVEDD,LVMI,and NT-proBNP were decreased compared with preoperative levels,and they were lower in the early group than in the conventional group(P<0.05).Immediately after surgery,the proportion of patients in the early group with TIMI blood flow grade 3 was higher than that in the conventional group,while the proportions of grades 1 and 2 were lower than those in the conventional group(P<0.05),and the TIMI corrected frame rate of LAD,RCA were lower than those in the conventional group(P<0.05).There was no significant difference in the incidence of MACE between the two groups within 3 months after surgery(P>0.05).Conclusion Early heparinization is beneficial for promoting cardiac function recovery and improving myocardial perfusion levels in STEMI patie

关 键 词：提前肝素化 经皮冠状动脉介入术 急性ST段抬高型心肌梗死 心功能恢复 心肌灌注 不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]