摘要
目的观察冠状动脉内逆向溶栓联合PCI对老年急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2020年9月—2021年9月上海交通大学附属第六人民医院南院心内科收治的老年STEMI患者120例,均在发病12 h内行急诊PCI术。随机数字表法分为直接PCI组(A组,n=40)、血栓抽吸+PCI组(B组,n=40)和冠状动脉内逆向溶栓+PCI组(C组,n=40)。比较3组术后的校正TIMI帧数(CTFC)、术后2 h ST段回落>50%比率、术后cTnI和BNP峰值,术后1周LVEF值、TIMI出血发生率及主要不良心血管事件。结果C组支架置入术后TIMI 3级比率显著高于A、B组,无复流或慢血流的发生率低于A、B组(P<0.05)。与A、B组比较,C组术后ST段下降≥50%的比率显著升高(χ^(2)=3.624,P=0.025),术后CTFC、肌钙蛋白、BNP水平降低,差异具有统计学意义(F/P=3.813/0.021、3.531/0.037、3.642/0.042),A、B组比较差异无统计学意义(P>0.05)。术后1周,与A、B组比较,C组患者cTnI、BNP水平降低,LVEF升高(F/P=3.561/0.032、3.271/0.042、3.812/0.021),A、B组比较差异无统计学意义(P>0.05)。3组术后均无TIMI大出血事件发生,小出血事件发生率比较差异无统计学意义(P>0.05);随访1个月,C组心力衰竭再住院率低于A组和B组(χ^(2)/P=3.270/0.040),LVEF高于A组和B组(F/P=3.560/0.030);3组心源性死亡发生率比较差异无统计学意义(P>0.05)。结论冠状动脉内逆向溶栓联合PCI可以改善老年急性ST段抬高型心肌梗死患者前向血流,保护更多的心肌细胞,改善短期预后,且不增加出血风险。
Objective To observe the effect of intracoronary reverse thrombolysis combined with PCI on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From September 2020 to September 2021,120 elderly patients with STEMI in the Department of Cardiology,South Hospital of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were selected,and they all received emergency PCI within 12 hours of onset.The patients were divided into primary PCI group(group A,n=40),thrombus aspiration+PCI group(group B,n=40)and intracoronary reverse thrombolysis+PCI group(group C,n=40)by random number table method.The postoperative corrected TIMI frame number(CTFC),the rate of ST segment fall>50%at 2 hours after operation,the peak value of cTnI and BNP after operation,the LVEF value of echocardiography at 1 week after operation,the incidence of TIMI bleeding and major adverse cardiac events were compared among the three groups.Results The rate of TIMI grade 3 after stent placement in group C was significantly higher than that in groups A and B,and the incidence of no reflow or slow blood flow was lower than that in groups A and B(P<0.05).Compared with groups A and B,the rate of ST segment decline≥50%in group C was significantly increased(χ^(2)=3.624,P=0.025),and the levels of CTFC,troponin,and BNP were decreased after operation,and the differences were statistically significant(F/P=3.813/0.021,3.531/0.037,3.642/0.042),there was no significant difference between groups A and B(P>0.05).One week after operation,compared with groups A and B,the levels of cTnI and BNP in group C were lower and LVEF was increased(F/P=3.561/0.032,3.271/0.042,3.812/0.021),and there was no difference between groups A and B(P>0.05).There were no TIMI major bleeding events in the three groups after surgery,and there was no significant difference in the incidence of minor bleeding events(P>0.05).LVEF was higher than group A and group B(F/P=3.560/0.030);there was no significant difference in the incidence of cardiac death among the three groups(P>0.05).Conclusion Intracoronary reverse thrombolysis combined with PCI can improve forward blood flow in elderly patients with acute ST-segment elevation myocardial infarction,protect more myocardial cells,and improve short-term prognosis without increasing the risk of bleeding.
作者
陈晓敏
葛广豪
马江伟
曹华
张立
刘化进
杨立国
张琼
乔增勇
Chen Xiaomin;Ge Guanghao;Ma Jiangwei;Cao Hua;Zhang Li;Liu Huajin;Yang Liguo;Zhang Qiong;Qiao Zengyong(Department of Cardiology,Shanghai Fengxian District Central Hospital,Shanghai 201499,China;不详)
出处
《疑难病杂志》
CAS
2022年第7期689-693,共5页
Chinese Journal of Difficult and Complicated Cases
基金
上海市奉贤区科学技术委员会课题(20191204)。
关键词
急性心肌梗死
ST段抬高型
冠状动脉内逆向溶栓
经皮冠状动脉介入
预后
老年人
Acute myocardial infarction,ST-segment elevation
Coronary inner reverse thrombolysis
Percutanous coronary intervention
Prognosis
Elderly
作者简介
通信作者:葛广豪,E-mail:13916207904@163.com。
