急性ST段抬高型心肌梗死患者的支架植入时机研究

发布时间：2018-03-25 22:22

本文选题：心肌梗死　切入点：血管成形术　出处：《中国全科医学》2017年04期

【摘要】：目的探讨急性ST段抬高型心肌梗死(STEMI)患者的支架植入时机。方法选取2015年1月—2016年6月在首都医科大学附属北京安贞医院心内科和北华大学附属医院心脏中心行急诊经皮冠状动脉介入治疗(PCI)支架植入术的急性STEMI患者351例,根据支架植入时机分为即刻支架组(n=310)和延迟支架组(n=41)。即刻支架组患者在接受经皮冠状动脉球囊扩张成形术(PTCA)后,即刻植入药物洗脱支架(DES);延迟支架组患者在接受PTCA后,停止PCI治疗,接受持续抗栓治疗7~12 d,然后植入DES。比较两组患者的病变与治疗情况、植入支架情况、术后效果及围术期主要心血管事件(MACE)发生率。结果两组患者梗死相关动脉(IRA)分布、血栓负荷评分比较,差异有统计学意义(P0.05);症状发生至球囊扩张时间、行血栓抽吸率比较,差异无统计学意义(P0.05)。两组患者植入支架数量、支架长度比较,差异有统计学意义(P0.05);植入支架直径比较,差异无统计学意义(P0.05)。两组患者心肌梗死溶栓试验(TIMI)3级率、心肌呈色分级(MBG)3级率及远端栓塞发生率比较,差异有统计学意义(P0.05)。两组患者围术期MACE发生率比较,差异有统计学意义(P0.05)。结论对于血流动力学不稳定的高血栓负荷STEMI患者,开通IRA后行延迟支架植入术,可明显减少其远端栓塞事件,改善心肌灌注,保护心脏整体功能,降低MACE发生率,增加患者获益。
[Abstract]:Objective to investigate the time of stent implantation in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods from January 2015 to June 2016, the patients were enrolled in cardiology department of Beijing Anzhen Hospital affiliated to Capital Medical University and Heart Center of affiliated Hospital of Beihua University. Emergency percutaneous coronary intervention was performed in 351 patients with acute STEMI undergoing PCI stent implantation. According to the time of stent implantation, the patients in the immediate stent group were divided into immediate stent group (n = 310) and delayed stent group (n = 41). After percutaneous transluminal coronary angioplasty and percutaneous transluminal coronary angioplasty (PTCA), drug-eluting stents were implanted immediately in the immediate stent group, and the patients in the delayed stent group were treated with PTCA. After stopping PCI therapy, receiving continuous antithrombotic therapy for 7d, then implanting DES.Compared with the patients in the two groups, the pathological changes and treatment, stenting, and stent implantation were compared between the two groups. Results the distribution of IRAs and the score of thrombus load were significantly different between the two groups (P < 0.05), the time between symptom and balloon dilation, and the rate of thrombotic suction were compared between the two groups. There was no significant difference in the number of stents and the length of stents between the two groups. There was no significant difference in stent diameter between the two groups. There was no significant difference between the two groups in the thrombolytic test of myocardial infarction. There was a significant difference in the rate of myocardial color grade 3 and distal embolism between the two groups (P 0.05). Conclusion there is a significant difference in the incidence of MACE in the perioperative period between the two groups. Conclusion there is a significant difference in the incidence of STEMI with high thrombus load in patients with unstable hemodynamics. After IRA, delayed stent implantation can significantly reduce the distal embolism events, improve myocardial perfusion, protect the whole heart function, reduce the incidence of MACE, and increase the benefit of patients.
【作者单位】：首都医科大学附属北京安贞医院心内科;北华大学附属医院心脏中心;
【分类号】：R542.22

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