CAJ | 학술논문

目的探讨不同方法经皮冠状动脉(冠脉)介入治疗(PCI)对ST段抬高心肌梗死(STEMI)远期疗效的影响. 方法选取2009年1月至2012年12月期间在我院住院的行急诊行PCI的STEMI患者65例,按治疗方法分为对照组29例和观察组36例,对照组直接行梗死相关动脉PCI治疗,观察组为冠脉内注射替罗非班联合血栓抽吸后,行梗死相关动脉PCI治疗,比较两组心肌再灌注临床指标、并发症发生率和随访1年心血管事件发生率. 结果治疗后观察组与对照组比较,无复流/慢血流现象发生率低(11.1％比24.1％,P＜0.01),病变血管心肌梗死溶栓试验(TIMI)血流分级高(2.9±0.2比2.1±0.3,P＜0.05),术后2h心电图ST段回落比例高(80.5％比62.1％,P＜0.01).术后10d,观察组脑钠肽水平低于对照组(P＜0.05),观察组LVEF高于对照组(P＜0.05).术后1年,观察组LVEF亦明显高于对照组,分别为(55.1±1 3.2)％比(49.0±11.5)％(P＜0.05);随访1年主要心血管不良事件(包括心绞痛、心肌梗死、心力衰竭、心因性死亡)发生率两组差异无统计意义(P＞0.05). 结论冠脉内注射替罗非班联合血栓抽吸导管抽吸及支架置入,能促进STEMI患者急诊PCI术后的ST段回落,可以最大程度缩小心肌坏死的范围,提高再灌注水平,改善心肌重塑,从而改善心肌功能.
목적 탐토불동방법경피관상동맥(관맥)개입치료(PCI)대ST단태고심기경사(STEMI)원기료효적영향. 방법 선취2009년1월지2012년12월기간재아원주원적행급진행PCI적STEMI환자65례,안치료방법분위대조조29례화관찰조36례,대조조직접행경사상관동맥PCI치료,관찰조위관맥내주사체라비반연합혈전추흡후,행경사상관동맥PCI치료,비교량조심기재관주림상지표、병발증발생솔화수방1년심혈관사건발생솔. 결과 치료후관찰조여대조조비교,무복류/만혈류현상발생솔저(11.1％비24.1％,P＜0.01),병변혈관심기경사용전시험(TIMI)혈류분급고(2.9±0.2비2.1±0.3,P＜0.05),술후2h심전도ST단회락비례고(80.5％비62.1％,P＜0.01).술후10d,관찰조뇌납태수평저우대조조(P＜0.05),관찰조LVEF고우대조조(P＜0.05).술후1년,관찰조LVEF역명현고우대조조,분별위(55.1±1 3.2)％비(49.0±11.5)％(P＜0.05);수방1년주요심혈관불량사건(포괄심교통、심기경사、심력쇠갈、심인성사망)발생솔량조차이무통계의의(P＞0.05). 결론 관맥내주사체라비반연합혈전추흡도관추흡급지가치입,능촉진STEMI환자급진PCI술후적ST단회락,가이최대정도축소심기배사적범위,제고재관주수평,개선심기중소,종이개선심기공능.
Objective To examine the long-term effects of two different percutaneous coronary intervention (PCI) procedures on ST segment elevation myocardial infarction (STEMI).Methods A total of 65 patients with STEMI undergoing emergency PCI from January 2009 to December 2012 at our hospital were enrolled in the study.Patients were divided into Group A,which received direct PCI in the infarct related artery (IRA) (n =29),and Group B,which received PCI after intracoronary tirofiban administration and thrombus aspiration (n =36).Clinical indicators of myocardial reperfusion,complication rates and cardiovascular events for both groups were followed up for one year and compared.Results Compared with Group B,the no reflow/slow flow rate decreased (11.1％ vs.24.1％,P＜0.01),TIMI grade flow increased [(2.9 ± 0.2) vs.(2.1 ± 0.3),P＜ 0.05] and the proportion of ECG ST-segment resolution 2h after PCI increased in Group A (80.5％ vs.62.1％,P＜0.01).Natriuretic peptide levels were lower in Group B than in Group A 10 days after PCI.Left ventricular ejection fractions (LVEF) 10 days and one year after PCI were both higher in Group B than in Group A respectively (P＜0.05).There were no statistical differences in the incidences of major adverse cardiovascular events including angina,myocardial infarction,heart failure and cardiac death between the two groups (P＞0.05 for all).Conclusions For STEMI patients who receive emergency PCI,the classical coronary intervention combined with intracoronary tirofiban administration and thrombus aspiration can promote ST-segment resolution,narrow the scope of myocardial necrosis,and improve the level of reperfusion and myocardial remodeling,thus boosting cardiac function.