急性ST段抬高型心肌梗死直接经皮冠状动脉介入术后心肌微循环灌注障碍的相关因素分析

发布时间：2018-04-02 02:34

  本文选题：急性ST段抬高型心肌梗死　切入点：直接经皮冠状动脉介入治疗　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:探讨急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,p PCI)术后心肌微循环灌注障碍的相关因素。方法:收集2015年2月至2016年12月于河北医科大学第二医院住院治疗的STEMI行p PCI治疗患者,根据TIMI心肌组织灌注分级(TIMI myocardial perfusion grade,TMPG)将患者分为两组:心肌微循环灌注不良组即A组(TMPG 0~2级者)和心肌微循环灌注良好组即B组(TMPG3级者)。收集患者临床基线资料,包括年龄、性别、是否吸烟、高脂血症、糖尿病、高血压、体重指数(body mass index,BMI)等。院前及术中资料,包括生化指标:血钾、肌酐、血红蛋白、血小板计数、低密度脂蛋白(Low Density Lipoprotein,LDL)、基线活化凝血时间(Activated Clotting Time,ACT)、肌酸激酶同工酶(Creatine Kinase-MB,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,c Tn I);心功能分级(Killip分级)、入院时收缩压、舒张压及心率、症状至首次医疗接触(first medical contact time,FMC)时间、FMC至肝素给予时间(FMC to heparin,FMC-H)、门球时间(door to balloon,D-B)、应用抽吸导管、多支病变、术前及术后TIMI血流、梗死相关动脉(Infarct Related Artery,IRA)、置入支架数量、支架长度及直径、预扩、后扩、支架释放压力、冠脉内是否应用替罗非班或山莨菪碱等。应用多因素Logistic回归分析探讨STEMI患者p PCI术后心肌微循环灌注障碍的独立危险因素。以P0.05为有统计学差异。统计软件采用SPSS16.0软件包。结果:入选符合条件的患者共122例,其中A组18例(14.75%)和B组104例(85.25%)。两组患者性别、年龄、BMI、吸烟、高脂血症、高血压、收缩压、舒张压、心率方面无统计学差异(P0.05),而糖尿病在A组比例明显高于B组,有统计学差异(44.44%vs.21.15%,P=0.034)。两组在血钾、肌酐、血红蛋白、血小板计数、LDL、基线ACT、CK-MB、c Tn I、Killip分级方面没有统计学差异(P0.05)。两组在IRA、支架直径及长度、释放压力、后扩张压力、术前TIMI血流(0级、1级、2级、3级)、术后TIMI血流(2级)方面无统计学差异(P0.05)。两组在多支病变方面,A组明显高于B组(77.8%vs.47.1%,P=0.016)。与B组相比,A组血栓抽吸应用比例明显增高(44.44%vs.1.92%,P0.001)。A组在替罗非班(50.00%vs.23.1%,P=0.018)、山莨菪碱(61.1%vs.17.3%,P0.001)方面应用均高于B组。A组后扩张比例高于B组(50%vs.20.19%,P=0.007),平均后扩张压力高于B组(0.89±1.02atm vs.0.28±0.60atm,P=0.024)。A组术后TIMI血流3级的比例明显低于B组(44.4%vs.76.9%,P=0.011)。两组在D-B方面无统计学差异(P0.05)。在症状-FMC方面,A组较B组更长(6.60±2.61h vs.3.96±1.72h,P0.001);在FMC-H方面,B组肝素给予时间更早(2.74±1.36h vs.1.38±0.72h,P0.001)。多因素Logistic回归分析显示:症状-FMC(OR=1.914,95%CI=1.054~3.569,P=0.037),FMC-H(OR=4.796,95%CI=1.336~17.214,P=0.016)为STEMI患者行p PCI术后心肌微循环灌注障碍的独立危险因素。结论:对于STEMI患者的救治,应最大限度地缩短心肌总缺血时间,包括及时就诊、尽早给予普通肝素阻断凝血瀑布链等,有效地预防p PCI术后心肌微循环灌注障碍的发生,减轻心肌缺血-再灌注损伤,挽救高质量的生命。
[Abstract]:Objective: To investigate the effect of acute ST elevation myocardial infarction (ST segment elevation myocardial infarction, STEMI) direct percutaneous coronary intervention (primary percutaneous coronary intervention, P PCI) related factors of postoperative myocardial microcirculation perfusion. Methods: from February 2015 to December 2016 in the second hospital of Hebei Medical University STEMI P PCI in the treatment of patients according to TIMI, myocardial perfusion grade (TIMI myocardial perfusion grade, TMPG) patients were divided into two groups: myocardial perfusion group (TMPG group, A bad 0~2 grade) and myocardial microcirculation perfusion group: B group (TMPG3 grade). The baseline clinical data were collected including age, gender, smoking, hyperlipidemia, diabetes, hypertension, body mass index (body mass, index, BMI). The data of before and during operation, including biochemical indexes: serum potassium, creatinine, hemoglobin, blood Platelet count, low density lipoprotein (Low Density, Lipoprotein, LDL), baseline activated clotting time (Activated Clotting, Time, ACT), creatine kinase isoenzyme (Creatine Kinase-MB, CK-MB), cardiac troponin I (cardiac troponin I C, Tn I); heart function classification (Killip classification), admission systolic blood pressure, diastolic pressure and heart rate, symptoms to the first medical contact (first medical contact time, FMC), FMC (FMC to to heparin given time heparin, FMC-H (door), to balloon, over time D-B), application of suction catheter, multivessel disease, preoperative and postoperative TIMI flow of infarct related artery (Infarct Related Artery, IRA), the number of stents, stent length and diameter, pre expansion, expansion, support the release of pressure, whether intracoronary tirofiban or anisodamine. Multivariate Logistic regression analysis of STEMI patients with P after PCI myocardial microcirculation perfusion 鐙�绔嬪嵄闄╁洜绱�.浠�P0.05涓烘湁缁熻�″�﹀樊寮，

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