STEMI患者紧急PCI术后无复流现象的观察研究

发布时间：2018-05-08 21:17

本文选题：无复流现象 + ST段抬高型心肌梗死　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的在发病12小时内接受紧急PCI术的急性ST段抬高型心肌梗死患者中,对比支架植入术后无复流组与正常血流组相关指标是否存在统计学差异,确定该类患者PCI术后无复流现象发生的独立危险因素,希望能够为今后无复流现象的临床防治工作提供相关参考依据。方法回顾性研究因急性STEMI入院,在发病12小时之内接受紧急PCI的患者共411例。依据术后TIMI血流评判方法将所有患者分为两组:无复流组(TIMI血流分级为0、1、2级者并入该组),正常血流组(TIMI血流分级为3级者入该组)。收集所有患者的基本临床资料:年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、脑血管病史、冠心病家族史、梗死前心绞痛、入院时发病时间、再灌注时间、收缩压、舒张压、Killip分级、ST段最大抬高幅度、术后1小时ST段回落程度、病理性Q波导联数。收集患者化验指标:白细胞计数、中性粒细胞百分比、淋巴细胞百分比、血小板计数、平均血小板体积、血小板分布宽度、肌酐、尿酸、肌酸激酶、肌酸激酶同工酶、超敏肌钙蛋白T、B型利纳肽前体、空腹血糖、载脂蛋白A、载脂蛋白B、超敏C反应蛋白、同型半胱氨酸、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白。收集患者冠脉造影资料:PCI术前TIMI血流分级、PCI靶血管、侧支循环、血栓、术中最大扩张压力、球囊扩张时间、预扩张次数、支架内扩张次数、后扩张次数、血栓抽吸、IABP的应用。收集患者术后MACE事件出现情况:术后AMI、血流动力学不稳定需再次手术、住院期间死亡。选择合适的统计学方法对无复流组与正常血流组患者的所有资料进行比较分析,判断有无统计学差异,明确12小时内行紧急PCI的急性STEMI患者术后出现无复流现象的独立危险因素。结果(1)本研究中无复流组患者共113例(男性82例,女性31例),正常血流组患者共298例(男性230例,女性68例),PCI术后无复流现象发生的概率27.5%。(2)通过比较基本临床资料,可以得出结果:两组患者在入院时发病时间、再灌注时间、收缩压、Killip分级、ST段最大抬高幅度、术后1小时ST段回落程度、病理性Q波导联数方面具有显著性差异,余指标没有显著性差异。(3)通过比较化验指标资料,可以得出结果:两组患者在白细胞计数、中性粒细胞百分比、淋巴粒细胞百分比、肌酸激酶、肌酸激酶同工酶、超敏肌钙蛋白T、B型利纳肽前体方面具有显著性差异,余指标没有显著性差异。(4)通过比较冠脉造影资料,可以得出结果:两组患者在PCI术前TIMI血流分级、PCI靶血管、无侧支循环、血栓、血栓抽吸方面具有显著性差异,余指标没有显著性差异。(5)通过比较术后MACE事件发生情况,可以得出结果:两组患者术后均未发生AMI,在血流动力学不稳定需再次手术、住院期间死亡方面没有显著性差异。(6)将所有资料进行Logistic回归分析得出结果:入院时发病时间、再灌注时间、ST段抬高最大幅度、病理Q波导联数、白细胞计数、中性粒细胞百分比、肌酸激酶同工酶、超敏肌钙蛋白T、无侧支循环是无复流现象的独立危险因素结论(1)无复流发生率27.5%。(2)入院时发病时间、再灌注时间、收缩压、Killip分级、ST段最大抬高幅度、术后1小时ST段回落程度、病理性Q波导联数、白细胞计数、中性粒细胞百分比、淋巴粒细胞百分比、肌酸激酶、肌酸激酶同工酶、超敏肌钙蛋白T、B型利纳肽前体、PCI术前TIMI血流分级、PCI靶血管、无侧支循环、血栓、血栓抽吸与无复流现象具有明显相关性。(3)入院时发病时间、再灌注时间、ST段抬高最大幅度、病理Q波导联数、白细胞计数、中性粒细胞百分比、肌酸激酶同工酶、超敏肌钙蛋白T、无侧支循环这几方面是12小时内行紧急PCI的急性STEMI患者术后出现无复流现象的独立危险因素。(4)缩短再灌注时间能够降低无复流现象发生率。
[Abstract]:Objective to determine whether there is a statistical difference between the non reflow group and the normal blood flow group after the stent implantation for acute ST segment elevation myocardial infarction within 12 hours of the onset of PCI, and to determine the independent risk factor for no reflow phenomenon after PCI operation in this type of patient, and hope to be a clinical non reflow phenomenon in the future. Methods the prevention and control work provided the reference basis. Methods a retrospective study of 411 patients receiving emergency PCI within 12 hours of onset of acute STEMI was reviewed. All patients were divided into two groups according to the postoperative TIMI flow evaluation method: no reflow group (TIMI blood flow classification as 0,1,2 group), and normal blood flow group (TIMI blood flow classification was grade 3) The basic clinical data of all patients: age, sex, smoking history, history of hypertension, hypertension, diabetes history, cerebrovascular history, family history of coronary heart disease, pre infarction angina, time of hospitalization, reperfusion time, systolic pressure, diastolic pressure, Killip classification, ST segment maximum elevation, 1 hours ST segment decline after operation, pathology, pathology, pathology, and pathology. Sex Q waveguide couplets. Collection of patient test indexes: leukocyte count, percentage of neutrophils, lymphocyte percentage, platelet count, average platelet volume, platelet distribution width, creatinine, uric acid, creatine kinase, creatine kinase isoenzyme, hypersensitivity troponin T, B type linapelin precursor, fasting blood glucose, apolipoprotein A, apolipoprotein B, B, super C reactive protein, homocysteine, total cholesterol, triglyceride, triglycerides, high-density lipoprotein, low density lipoprotein. Collection of patients with coronary angiography: preoperative TIMI blood flow classification, PCI target vessel, collateral circulation, thrombus, maximum dilation pressure, balloon dilatation time, number of predilatation, number of dilatation in stents, post dilatation times, thrombus extraction Aspiration, the application of IABP. Collect the occurrence of postoperative MACE events in patients: postoperative AMI, hemodynamic instability need to be reoperated and hospitalized. Choose appropriate statistical methods to compare and analyze all data in the non reflow group and the normal blood flow group, to determine whether there is any statistical difference, and to clarify the acute ST for emergency PCI in 12 hours. EMI patients had independent risk factors without reflow after operation. Results (1) there were 113 patients without reflow group (82 males and 31 females), 298 cases in normal blood flow group (230 men, 68 women), the probability of no reflow phenomenon after PCI (2) through comparison of basic clinical data, the results could be obtained in two groups of patients. The onset time, reperfusion time, systolic blood pressure, Killip classification, ST segment maximum elevation, 1 hours ST segment decline degree after operation, pathological Q waveguides have significant differences, and there is no significant difference in the residual index. (3) the results can be obtained by comparing the data of the test index: the two groups of patients are in leukocyte count, neutrophils Percentage, percentage of lymphogranulocyte, creatine kinase, creatine kinase isoenzyme, hypersensitive troponin T, B type linactin precursors, there were significant differences, and there was no significant difference in the residual index. (4) the results were obtained by comparing the data of coronary angiography: the two groups were graded before PCI, PCI target vessel, no collateral circulation, thrombus, There was significant difference in thrombus aspiration, and there was no significant difference in the residual index. (5) by comparing the occurrence of MACE events after the operation, the results were obtained: the two groups had no AMI after operation, the reoperation needed to be reoperated in the hemodynamic instability and there was no significant difference in death during the hospitalization. (6) all the data were divided into Logistic regression. The results were as follows: the time of admission, the time of reperfusion, the maximum elevation of ST segment, the number of pathological Q waveguides, the white blood cell count, the percentage of neutrophils, the creatine kinase isozyme, the hypersensitivity troponin T, the no collateral circulation is an independent risk factor for no reflow phenomenon (1) the incidence of no reflow rate of 27.5%. (2), and reperfusion time. Time, systolic pressure, Killip grade, ST segment maximum elevation, 1 hours ST segment drop, pathological Q waveguide couplet, leukocyte count, neutrophil percentage, lymphogranulocyte percentage, creatine kinase, creatine kinase isoenzyme, hypersensitive troponin T, B type leninin precursor, PCI preoperative TIMI blood flow classification, PCI target vessel, unlateral There was a significant correlation between the branched circulation, thrombus, thrombus aspiration and no reflow. (3) the time of admission, the time of reperfusion, the maximum elevation of ST segment elevation, the number of pathological Q waveguides, the white cell count, the percentage of neutrophils, the creatine kinase isoenzyme, the hypersensitivity muscle calcium egg white T, and the non collateral circulation are the acute PCI acute in several aspects. STEMI patients had independent risk factors for no reflow after operation. (4) shortening reperfusion time could reduce the incidence of no reflow phenomenon.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

【参考文献】