肝素预处理对急性ST段抬高型心肌梗死冠脉血流动力学及预后的影响研究  

Effect of heparin pretreatment on coronary hemodynamics and prognosis in acute ST-segment elevation myocardial infarction

作　　者：谢爱娟 王阳阳 XIE Aijuan;WANG Yangyang(Department of Emergency,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China;Department of Cardiovascular Medicine,Pingdingshan the Second People's Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]河南科技大学第二附属医院急诊科,河南洛阳471000 [2]平顶山市第二人民医院心血管内科,河南平顶山467000

出　　处：《中国医学工程》2025年第4期49-53,共5页China Medical Engineering

基　　金：河南省医学科技攻关项目(LHGJ2020021837)。

摘　　要：目的观察肝素预处理对急性ST段抬高型心肌梗死(STEMI)患者冠脉血流动力学及预后情况的影响。方法从河南科技大学第二附属医院2022年1月至2023年10月收治的STEMI患者中随机抽取109例,经电脑随机分组法将其分别列为经皮冠脉介入(PCI)组(54例)和肝素组(55例),PCI组直接实施急诊PCI治疗,肝素组术前应用肝素预处理辅助急诊PCI,比较两组患者的冠脉血流动力学参数、心肌损伤标志物、冠脉造影结果、心功能指标及预后情况。结果在不同治疗方案下,肝素组的冠脉血流收缩期峰值流速(SPV)、冠脉血流舒张期峰值流速(DPV)、冠脉血流速度储备(CFVR)分别为(15.25±3.31)cm/s、(30.29±5.33)cm/s、(3.43±0.36),均高于PCI组[(13.39±3.25)cm/s、(27.66±5.41)cm/s、(2.65±0.72)](P<0.05);肝素组的肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)分别为(61.35±10.26)μg/L、(10.44±2.28)U/L、(40.31±10.19)U/L,均低于PCI组[(66.29±10.44)μg/L、(12.28±3.41)U/L、(45.36±10.22)U/L](P<0.05);肝素组的血栓溶解率为90.91%(50/55),高于PCI组[59.26%(32/54)](P<0.05),高血栓负荷率、心肌血流慢/无复流发生率分别为5.45%(3/55)、3.64%(2/55),均低于PCI组[22.22%(12/54)、18.52%(10/54)](P<0.05);肝素组的左心室射血分数(LVEF)为(55.25±10.36)%,高于PCI组[(50.28±10.32)%](P<0.05),左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)分别为(115.41±20.45)mL、(55.32±10.49)mL,均低于PCI组[(130.33±20.55)mL、(60.29±10.62)mL](P<0.05);肝素组的主要心血管不良事件(MACE)发生率为1.82%(1/55),低于PCI组[18.52%(10/54)](P<0.05)。结论肝素预处理能改善STEMI冠脉血流动力学,对减轻患者PCI术后心肌损伤、增强治疗效果、促进心功能恢复并降低MACE发生风险均有积极意义。【Objective】To observe the effects of heparin pretreatment on coronary hemodynamics and prognosis in STsegment elevation myocardial infarction(STEMI)patients.【Methods】This was a prospective study,and 109 STEMI patients admitted to the Second Affiliated Hospital of Henan University of Science and Technology from January 2022 to October 2023 were selected.They were divided into the percutaneous coronary intervention(PCI)group(54 cases)and the heparin group(55 cases)using computer random grouping method.The PCI group received emergency PCI treatment directly,while the heparin group received preoperative heparin pretreatment to assist emergency PCI.The coronary hemodynamic parameters,myocardial injury markers,coronary angiography results,cardiac function indicators,and prognosis of the two groups of patients were compared.【Results】Under different treatment regimens,the systolic peak velocity(SPV),diastolic peak velocity(DPV),and coronary flow velocity reserve(CFVR)of the heparin group were 15.25±3.31 cm/s,30.29±5.33 cm/s,and 3.43±0.36,higher than the PCI group(13.39±3.25 cm/s,27.66±5.41 cm/s,and 2.65±0.72)(P<0.05).The myoglobin(MYO),creatine kinase-myocardial band(CK-MB),and lactate dehydrogenase(LDH)of the heparin group were 61.35±10.26μg/L,10.44±2.28 U/L,and 40.31±10.19 U/L,lower than those in the PCI group(66.29±10.44μg/L,12.28±3.41 U/L,45.36±10.22 U/L)(P<0.05).The thrombolysis rate of the heparin group[90.91%(50/55)]was higher than that of the PCI group[59.26%(32/54)](P<0.05).The high thrombus burden rate and the incidence of slow/no reflow in myocardial blood flow of the heparin group were 5.45%(3/55)and 3.64%(2/55),lower than those of the PCI group[22.22%(12/54)and 18.52%(10/54)](P<0.05).The left ventricular ejection fraction(LVEF)of the heparin group(55.25%±10.36%)was higher than that of the PCI group(50.28%±10.32%),and the left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were 115.41±20.45 mL and 55.32±10.49 mL,lower than the PCI group(130.

关 键 词：急性ST段抬高型心肌梗死 肝素预处理 经皮冠脉介入术 冠脉血流动力学 预后情况 

分 类 号：R542.22[医药卫生—心血管疾病]