冠状动脉侧枝循环形成对急性心肌梗死患者行急诊PCI术预后的影响

发布时间：2018-01-15 19:43

本文关键词：冠状动脉侧枝循环形成对急性心肌梗死患者行急诊PCI术预后的影响　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨冠状动脉侧枝循环（Coronary collateral circulation，CCC）对急性心肌梗死（Acute myocardial infarction，AMI）患者行急诊经皮冠状动脉介入治疗（Percutaneous coronary intervention，PCI）预后的影响。方法选择107例确诊为AMI并行急诊PCI术的患者，根据术中冠脉造影结果，按侧枝循环的有无分为侧枝循环组和非侧枝循环组，记录两组患者相关临床信息。对两组患者平均随访6-10（8.9±1.8）月，观察其随访期间主要不良心血管事件（Major adverse cardiovascular events，MACE）、氨基末端B型脑钠肽前体（N-terminal Pro-Brain Natriuretic Peptide，NT-proBNP）、左室射血分数（Left ventricular ejection fraction，LVEF）、Gensini积分、心绞痛病史、进门至球囊扩张（Door-to-Balloon，D2B）时间等临床数据进行了对比分析，以综合评价侧枝循环对患者预后的影响。结果侧枝循环组术后NT-proBNP水平明显低于非侧枝循环组，差异有统计学意义（P=0.048）。侧枝循环组术前和术后LVEF水平高于非侧枝循环组，差异有统计学意义（P=0.043、P=0.042）。侧枝循环组Gensini积分水平高于非侧枝循环组，差异有统计学意义（P=0.034）。侧枝循环组心绞痛病史天数多于非侧枝循环组，差异有统计学意义（P=0.023）。侧枝循环组近期MACE发生比例与非侧枝循环组比较，差异无统计学意义（P=0.299）。结论对于患有AMI行急诊PCI术的病人而言，侧枝循环的形成可明显改善冠脉血供，减少梗死面积；侧枝循环组病人的心绞痛病史较长，冠脉病变较重，但是由于侧枝循环的存在，，其术后LVEF、NT-proBNP较无侧枝循环组好，说明侧枝循环对于心肌缺血的病人起保护作用，但近期MACE发生比例与无侧枝循环的、冠脉病变轻的患者相比两者没有区别。
[Abstract]:Objective to investigate the coronary collateral circulation of coronary artery collateral circulation. CCCs were used to treat acute myocardial infarction in patients with acute myocardial infarction. Acute percutaneous coronary intervention (PCI) was performed in patients with acute coronary artery disease (AMI). Methods according to the results of coronary angiography, 107 patients diagnosed as AMI and emergency PCI were divided into collateral circulation group and non-collateral circulation group according to the results of coronary angiography. The patients in both groups were followed up for an average of 6-108.9 卤1.8 months. Major adverse cardiovascular events were observed during follow-up. N-terminal Pro-Brain Natriuretic peptide NT-proBNPs. Left ventricular ejection fraction (LVEF) and left ventricular ejection fractionator Gensini score, history of angina pectoris. In order to evaluate the influence of collateral circulation on the prognosis of patients, the clinical data such as door-to-Balloonus D2B time from entrance to balloon dilatation were compared and analyzed. Results the level of NT-proBNP in collateral circulation group was significantly lower than that in non-collateral circulation group. The level of LVEF in the lateral branch circulation group was higher than that in the non-lateral branch circulation group before and after operation, and the difference was statistically significant (P 0.043). The Gensini integral level of lateral branch circulation group was higher than that of non-lateral branch circulation group. The difference was statistically significant (P < 0.034). The number of days of angina pectoris history in collateral circulation group was longer than that in non-lateral branch circulation group. There was no significant difference in the incidence rate of MACE between the lateral branch circulation group and the non-lateral branch circulation group. There was no significant difference in the incidence of MACE between the lateral branch circulation group and the non-lateral branch circulation group. Conclusion for patients with AMI undergoing emergency PCI, the formation of collateral circulation can significantly improve the coronary blood supply and reduce the infarct size. The history of angina pectoris was longer and the coronary artery lesion was more serious in the collateral circulation group, but because of the existence of collateral circulation, the LVEFN NT-proBNP was better than the non-collateral circulation group. These results suggest that collateral circulation plays a protective role in patients with myocardial ischemia, but there is no difference in the incidence of MACE between the patients without collateral circulation and the patients with mild coronary artery lesion.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R542.22

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