中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2011年
1期
44-47
,共4页
王怀新%孙丽云%胡奉环%童雨田%姜忠宾
王懷新%孫麗雲%鬍奉環%童雨田%薑忠賓
왕부신%손려운%호봉배%동우전%강충빈
ST段抬高型急性心肌梗死%心脏介入治疗%血栓抽吸
ST段抬高型急性心肌梗死%心髒介入治療%血栓抽吸
ST단태고형급성심기경사%심장개입치료%혈전추흡
Acute ST- segments elevation myocardial infarction%Percutaneous cardiac intervention%Thrombus aspiration
目的 探讨序贯再通经皮冠状动脉介入治疗(PCI)对急性S-T段抬高型急性心肌梗死(STEMI)是否能提高心肌水平再灌注级别.方法 将123例STEMI患者随机分为序贯再通PCI治疗组62例和传统的直接PCI组61例.对比观察两组患者在介入治疗过程中和介入治疗后心肌水平再灌注情况.结果 两组无再流TIMI血流≤1级发生率比较差异有统计学意义(4.83% vs 16.39%,P=0.04),序贯再通PCI治疗组无复流发生率偏低.心肌呈色分级(MBG)≤1级作为心肌水平无灌注,其发生率两组比较差异有统计学意义(9.67% vs 27.87%,χ2=6.48,P=0.01);MBG 2级和MBG 3级为心肌水平有灌注,两组比较差异有统计学意义(90.32% vs 72.13%,χ2=6.69,P=0.01),即序贯再通PCI组血流灌注较好.以序贯再通PCI为变量,对心肌水平无灌注的影响进行Logistic回归分析,结果其OR值为0.282,95%CI:0.10～0.77,P=0.02;对心肌水平灌注的影响OR为3.54,95%CI:1.29～9.66,P=0.03,影响心肌水平无灌注的其他因素还有:发病到IRA开始再通的时间(OR=4.14,95%CI:1.21～10.33,P=0.01)、年龄(OR=2.27,95%CI:1.38～9.44,P=0.04)和糖尿病(OR=2.05,95%CI:1.27～7.68,P=0.04).结论 序贯再通PCI治疗可改善STEMI患者心肌水平的血流灌注,优于传统的PCI疗法,尤其适合有糖尿病的老年人.
目的 探討序貫再通經皮冠狀動脈介入治療(PCI)對急性S-T段抬高型急性心肌梗死(STEMI)是否能提高心肌水平再灌註級彆.方法 將123例STEMI患者隨機分為序貫再通PCI治療組62例和傳統的直接PCI組61例.對比觀察兩組患者在介入治療過程中和介入治療後心肌水平再灌註情況.結果 兩組無再流TIMI血流≤1級髮生率比較差異有統計學意義(4.83% vs 16.39%,P=0.04),序貫再通PCI治療組無複流髮生率偏低.心肌呈色分級(MBG)≤1級作為心肌水平無灌註,其髮生率兩組比較差異有統計學意義(9.67% vs 27.87%,χ2=6.48,P=0.01);MBG 2級和MBG 3級為心肌水平有灌註,兩組比較差異有統計學意義(90.32% vs 72.13%,χ2=6.69,P=0.01),即序貫再通PCI組血流灌註較好.以序貫再通PCI為變量,對心肌水平無灌註的影響進行Logistic迴歸分析,結果其OR值為0.282,95%CI:0.10～0.77,P=0.02;對心肌水平灌註的影響OR為3.54,95%CI:1.29～9.66,P=0.03,影響心肌水平無灌註的其他因素還有:髮病到IRA開始再通的時間(OR=4.14,95%CI:1.21～10.33,P=0.01)、年齡(OR=2.27,95%CI:1.38～9.44,P=0.04)和糖尿病(OR=2.05,95%CI:1.27～7.68,P=0.04).結論 序貫再通PCI治療可改善STEMI患者心肌水平的血流灌註,優于傳統的PCI療法,尤其適閤有糖尿病的老年人.
목적 탐토서관재통경피관상동맥개입치료(PCI)대급성S-T단태고형급성심기경사(STEMI)시부능제고심기수평재관주급별.방법 장123례STEMI환자수궤분위서관재통PCI치료조62례화전통적직접PCI조61례.대비관찰량조환자재개입치료과정중화개입치료후심기수평재관주정황.결과 량조무재류TIMI혈류≤1급발생솔비교차이유통계학의의(4.83% vs 16.39%,P=0.04),서관재통PCI치료조무복류발생솔편저.심기정색분급(MBG)≤1급작위심기수평무관주,기발생솔량조비교차이유통계학의의(9.67% vs 27.87%,χ2=6.48,P=0.01);MBG 2급화MBG 3급위심기수평유관주,량조비교차이유통계학의의(90.32% vs 72.13%,χ2=6.69,P=0.01),즉서관재통PCI조혈류관주교호.이서관재통PCI위변량,대심기수평무관주적영향진행Logistic회귀분석,결과기OR치위0.282,95%CI:0.10～0.77,P=0.02;대심기수평관주적영향OR위3.54,95%CI:1.29～9.66,P=0.03,영향심기수평무관주적기타인소환유:발병도IRA개시재통적시간(OR=4.14,95%CI:1.21～10.33,P=0.01)、년령(OR=2.27,95%CI:1.38～9.44,P=0.04)화당뇨병(OR=2.05,95%CI:1.27～7.68,P=0.04).결론 서관재통PCI치료가개선STEMI환자심기수평적혈류관주,우우전통적PCI요법,우기괄합유당뇨병적노년인.
Objective To explore whether sequel recanalization PCI therapy (primary coronary intervention, PCI) can improve myocardial blush grades for the patients with acute ST segment elevation myocardial infarction (STEMI). Methods One hundred and twenty- three patients with STEMI enrolled were randomly divided into two groups: sequel recanalization PCI group (62 cases)and conventional PCI group (61cases), to observe how many TIMI grades and MBG grades of the two groups during and after PCI procedure, respectively. Results There were significant differences between the two groups in TIMI grade≤ (4. 83% vs 16.39% , χ2 =3.68, P =0.04) , it shows that the rate of no - reflow of sequel reeanalization PCI group was lower than that of conventional PCI group. And, there was significant difference between the two groups in MBG grade≤ (9.67% vs 27.87%, χ2=6.48, P =0.01), and MBG2 -3(90.32% vs 72.13%, χ2 =6.69, P =0. 01 ). If sequel recanalization PCI served as a variable for predicting MBG grade 0 - 1, the results of Logistic regression showed that OR ( odds ratio) value was 0. 282,95 % CI ( confidence interval)0. 103-0.776, P =0.02;If for predicting MBG grade2-3, its OR 3.54, 95% CI: 1.29-9. 66, P = 0. 03. Among other variables, as was time - to - reeanalization (OR4. 14, P =0. 01 ),age (OR 2. 27, P = 0. 03 ), diabetes (OR 2. 05, P = 0. 04). Conclusions The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in myocardial blush grades, therefore, it should be chioced for the old patients,especially diabetes.
