摘要
目的 探讨急性ST段抬高型心肌梗死(STEMI)不同治疗方式的临床疗效。方法 选取保定市第一医院106例STEMI患者的临床资料进行回顾性分析,选取时间为2018年5月—2020年6月,按照治疗方法不同分为急诊经皮冠状动脉介入治疗PCI组(n=37)、溶栓后早期PCI组(n=35)、溶栓后择期PCI组(n=34),比较三组患者的左心室舒张末期内径(LVDd)、左心室射血分数(LVEF)、心肌梗死溶栓试验(TIMI)血流分级、神经生长因子(NGF)、心脏肌球蛋白结合蛋白(cMyBP-C)水平;观察术后6个月内不良事件。结果 重复测量方差分析显示,三组LVDd、LVEF、NGF、cMyBP-C的时点效应、组间效应、时点与组间的交互效应比较,差异具有统计学意义(P<0.05);单因素方差比较,术前,三组LVDd、LVEF、NGF、cMyBP-C比较,差异无统计学意义(P>0.05);入院时,三组NGF、cMyBP-C比较,差异无统计学意义(P>0.05)。两两比较显示,治疗后7 d、6个月,溶栓后早期PCI组的LVDd低于急诊PCI组和溶栓后择期PCI组,而LVEF高于急诊PCI组和溶栓后择期PCI组(P<0.05)。PCI术前,溶栓后早期PCI组和溶栓后择期PCI组的NGF、cMyBP-C低于急诊PCI组(P<0.05);PCI术后,溶栓后早期PCI组的NGF、cMyBP-C低于急诊PCI组和溶栓后择期PCI组(P<0.05)。在冠状动脉TIMI血流分级比较中,溶栓后早期PCI组TIMI血流分级3级占比最高,但三组比较差异无统计学意义(P>0.05)。溶栓后早期PCI组的不良事件总发生率低于急诊PCI组、溶栓后择期PCI组(P<0.05)。结论 急诊PCI、溶栓后早期PCI及溶栓后择期PCI均能有效改善STEMI患者的心功能,但溶栓后早期PCI改善效果更为理想。
Objective To investigate the clinical efficacy of different treatments for acute ST-segment elevation myocardial infarction.Methods The clinical data of 106 STEMI patients in Baoding No.1 Hospital were selected for retrospective analysis.The selection time was from May 2018 to june 2020.According to the treatment method,they were divided into emergency PCI group(n=37)and early PCI group after thrombolysis(n=35),the elective PCI group after thrombolysis(n=34),compare the left ventricular end diastolic diameter(LVDd),left ventricular ejection fraction(LVEF),coronary TIMI blood flow classification,NGF,cMyBP-C;observation 6 adverse events within months.Results Repeated measures analysis of variance showed that the three groups of LVDd,LVEF,NGF,cMyBP-C had statistical differences in time-point effects,inter-group effects,and interaction effects between time-points and groups(P<0.05);single-factor variance comparison Before the operation,there was no statistically significant difference between the three groups of LVDd,LVEF,NGF,and cMyBP-C(P>0.05);on admission,the three groups of NGF,cMyBP-C were not statistically different(P>0.05).Pairwise comparison showed that 7 days and 6 months after treatment,the LVDd of the early PCI group after thrombolysis was lower than that of the emergency PCI group and the elective PCI group after thrombolysis,while the LVEF was higher than that of the emergency PCI group and the elective PCI group after thrombolysis(P<0.05).Before PCI,NGF and cMyBP-C in the early PCI group after thrombolysis and the elective PCI group after thrombolysis were lower than those in the emergency PCI group(P<0.05);after PCI,NGF and cMyBP-C in the early PCI group after thrombolysis It was lower than that in the emergency PCI group and elective PCI group after thrombolysis(P<0.05).In the comparison of coronary TIMI blood flow grades,the proportion of TIMI blood flow grade 3 in the early PCI group after thrombolysis was highest,but there was no significant difference between the three groups(P>0.05).The total incidence of adverse events in the early PCI group after thrombolysis was lower than that in the emergency PCI group and the elective PCI group after thrombolysis(P<0.05).Conclusion Emergency PCI,early PCI after thrombolysis and elective PCI after thrombolysis can effectively improve the heart function of STEMIpatients, but the improvement effect of early PCI after thrombolysis is more ideal.
作者
胡丹
王肖雅
王斌
谢肖立
HU Dan;WANG Xiaoya;WANG Bin;XIE Xiaoli(Baoding No.1 Hospital,Baoding Heibei 071000,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第10期1276-1279,1284,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
国家自然科学基金资助项目(编号:816025)
保定市科研计划项目(编号:2041ZF064)。
关键词
急性ST段抬高型
心肌梗死
经皮冠状动脉介入
溶栓
心功能
Acute ST-segment elevation myocardial infarction
Percutaneous coronary intervention
Thrombolysis
Cardiac function
