CAJ | 학술논문

目的：探讨血管内超声（IVUS）在ST段抬高型心肌梗死（STEMI）患者急诊介入诊疗中的应用。方法选择冠状动脉造影（CAG）提示心肌梗死相关血管（IRA）固定狭窄为临界病变的STEMI患者80例，发病在12小时内，并且远端血流TIMIⅢ级；随机分为IVUS组（试验组）38例和未行IVUS组（对照组）42例；对照组全部置入支架，试验组进一步经IVUS评价病变分为低危和高危患者，决定是否置入支架；观察两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率，左心室舒张末期内径（LVEDD）及射血分数（EF）值的变化，支架置入的个数。结果两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率比较无明显差异，两组LVEDD及EF值比较无明显差异（P＞0.05）；试验组比对照组支架置入的个数减少，差异有显著性（P＜0.05）。结论在IVUS指导下的急诊介入诊疗中，STEMI低危患者不置入支架也是安全的、可行的，减少了患者支架置入数量。
목적：탐토혈관내초성（IVUS）재ST단태고형심기경사（STEMI）환자급진개입진료중적응용。방법선택관상동맥조영（CAG）제시심기경사상관혈관（IRA）고정협착위림계병변적STEMI환자80례，발병재12소시내，병차원단혈류TIMIⅢ급；수궤분위IVUS조（시험조）38례화미행IVUS조（대조조）42례；대조조전부치입지가，시험조진일보경IVUS평개병변분위저위화고위환자，결정시부치입지가；관찰량조환자주원기간、술후1개월、3개월、6개월、1년심장주요불량사건발생솔，좌심실서장말기내경（LVEDD）급사혈분수（EF）치적변화，지가치입적개수。결과량조환자주원기간、술후1개월、3개월、6개월、1년심장주요불량사건발생솔비교무명현차이，량조LVEDD급EF치비교무명현차이（P＞0.05）；시험조비대조조지가치입적개수감소，차이유현저성（P＜0.05）。결론재IVUS지도하적급진개입진료중，STEMI저위환자불치입지가야시안전적、가행적，감소료환자지가치입수량。
Objective Explore intravascular ultrasound (IVUS) in patients with acute ST-segment elevation myocardial infarction (STEMI) in the application of emergency intervention. Methods Eighty patients within 12 h of a STEMI episode , who had ifxed stenosis (50%to 75%stenosis) of infraction related artery(IRA) by the coronary angiography (CAG) identiifed as the coronary intermediate lesion ,accompanying with a TIMI 3 lfow at the distal end of the coronary artery, were included. These patients were randomly divided into the IVUS (test group, n=38) and non-IVUS groups (control group, n=42). All the patients in the control group were implanted the stent, while the test group was further divided into the low-risk patients and high-risk patients according to the evaluation of IVUS, and then decided whether implanting the stent or not. We observed the incidence of the major cardiovascular events, the change of the left ventricular end diastolic diameter (LVEDD) and ejection fraction (EF), the number of stents implantation among the hospitalisation and 1, 3, 6 and 12 months after the surgery. Results There were no statistical signiifcant differences of incidence of adverse cardiac events, LVEDD and EF between the two groups among the hospitalisation and 1, 3, 6 and 12 months after the surgery (P>0.05). The number of stents implantation in the test group was signiifcantly less than the control group (P<0.05). Conclusion Under the guide of IVUS in emergency intervention, it was safe and feasible for the low-risk STEMI patients without stent implantation, reducing the stent implantation.