摘要
目的分析不同肝素给予时机对行经皮冠脉介入治疗(PCI)的急性心肌梗死(AMI)患者主要不良心血管事件(MACE)发生率及血清心肌标志物达峰时间的影响。方法纳入我院2019年1月至2020年5月收治的200例行PCI的AMI患者为研究对象,采取信封随机法将其分为对照组(n=100,术中予以肝素)和试验组(n=100,行PCI时立即予以肝素)。比较两组的手术相关指标、MACE发生情况及血小板最大聚集率。结果与对照组比较,试验组的术前活化凝血时间(ACT)更长,血栓抽吸占比、慢血流发生率更低,血管开通时间、肝素给药时间及血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)达峰时间更短,术后72 h左心室射血分数(LVEF)及左心室舒张早期二尖瓣血流最大流速/心房收缩期二尖瓣血流最大流速(E/A)更高,差异具有统计学意义(P<0.05)。试验组的MACE总发生率为4.00%,显著低于对照组的35.00%,差异具有统计学意义(P<0.05)。试验组用药后10 min、手术结束时、手术结束后1 h的血小板最大聚集率均低于对照组,差异具有统计学意义(P<0.05)。结论对于行PCI的AMI患者,行PCI时立即予以肝素能获得较好的治疗效果,有助于降低血小板最大聚集率,减少MACE发生,改善预后。
Objective To analyze the effects of different timing of heparin administration on the incidence of major adverse cardiovascular events(MACE)and the peak time of serum myocardial markers in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods Two hundred AMI patients undergoing PCI in our hospital from January 2019 to May 2020 were included as the research objects and divided into control group(n=100,heparin was given during operation)and experimental group(n=100,heparin was given immediately during PCI)according to random envelope method.The operation related indexes,the occurrence of MACE and maximum platelet aggregation rate were compared between the two groups.Results Compared with the control group,the experimental group had longer preoperative activated clotting time(ACT),lower proportion of thrombus aspiration and incidence of slow blood flow,shorter vascular opening time,heparin administration time and peak time of serum cardiac troponin I(cTnI)and creatine kinase isoenzyme-MB(CK-MB),higher left ventricular ejection fraction(LVEF)and left ventricular early diastolic mitral flow maximum velocity/atrial systolic mitral flow maximum velocity(E/A)at 72 h after operation,and the differences were statistically significant(P<0.05).The total incidence of MACE in the experimental group was 4.00%,which was significantly lower than 35.00%in the control group,and the difference was statistically significant(P<0.05).The maximum platelet aggregation rate in the experimental group at 10 min after administration,the end of surgery and 1 h after surgery was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion For AMI patients undergoing PCI,immediate heparin administration during PCI can achieve better therapeutic effect,which helps to decrease the maximum platelet aggregation rate,reduce the occurrence of MACE and improve the prognosis.
作者
罗磊
任小鹏
王文锋
LUO Lei;REN Xiaopeng;WANG Wenfeng(Shangluo Central Hospital,Shangluo 726000,China)
出处
《临床医学研究与实践》
2022年第22期37-40,共4页
Clinical Research and Practice
基金
商洛市科技计划项目(No.SK2019-68)。
关键词
急性心肌梗死
经皮冠脉介入治疗
肝素
主要不良心血管事件
血清心肌标志物
acute myocardial infarction
percutaneous coronary intervention
heparin
major adverse cardiovascular events
serum myocardial marker
作者简介
罗磊(1985-),男,副主任医师,学士。研究方向:心力衰竭、急性心肌梗死等心内科疾病的治疗;通讯作者:任小鹏,E-mail:yyzz0238@163.com。
