不同途径注射前列腺素E_1对急性非ST段抬高型心肌梗死行早期介入治疗术的预后评价

Prognosis evaluation of prostaglandin E_1 injected by different approaches in treating patients with acute non-ST segment elevation myocardial infarction by percutaneous coronary intervention in early stage

目的探讨经冠脉和经外周静脉注射前列腺素E_1对急性非ST段抬高型心肌梗死(NSTEMI)患者早期(发病24 h以内)经皮冠状动脉介入治疗(PCI)后即刻疗效及主要心脏不良事件(MACE)的影响。方法选取本院136例诊断为急性非ST段抬高型心肌梗死的住院患者,均于发病24 h内行早期PCI治疗。随机分为经冠脉注射组、经外周静脉注射组和常规治疗组,随访9个月,比较3组患者PCI术中发生无复流或者慢血流的情况,住院期间和随访9个月期间发生心绞痛、心力衰竭、靶血管再次血运重建率、再发心肌梗死以及心源性死亡等主要心脏不良事件(MACE)的情况。比较PCI术后9个月左室舒张末期内径(LVDd)、左室射血分数(LVEF)等指标的变化情况。结果 PCI术中校正的TIMI血流帧数计数(CTFC)、TIMI心肌灌注分级(TMP)为经冠脉注射组显著优于经外周静脉注射组和常规治疗组(P<0.05),经外周静脉注射组显著优于常规治疗组(P<0.05)。随访9个月后查超声心动图,LVDd为经冠脉注射组<经外周静脉注射组<常规治疗组(P<0.05)。比较LVEF,经冠脉注射组>经外周静脉注射组>常规治疗组(P<0.05)。总MACE发生率为经冠脉注射组显著少于经外周静脉注射组和常规治疗组(P<0.05),而经外周静脉注射组较常规治疗组有减少(P>0.05),3组均无死亡事件。结论对于NSTEMI患者早期PCI时,经冠脉内注射和经外周静脉注射前列腺素E_1,术中均能获得更好的心肌微循环再灌注,经冠脉内注射可显著减少心脏不良事件的发生。

Objective To explore the clinical efficacy of prostaglandin E1 injected by coro-nary or peripheral venous in early stage （within 24 h of symptom onset） in non-ST segment elevation myocardial infarction （ NSTEMI） by percutaneous coronary intervention （PCI） and its influence on major adverse cardiac events （MACE） . Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group, periphvein injection group and control group. All the patients were followed up for 9 months,no reflow orslow blood flow , the incidence of angina pectoris , heart failure , and target vessel revascularization , re-current myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups. The changes of left ventricular end diastolic diameleft ventricular ejection fraction （LVEF） and other indicators were compared. Resulcorrected TIMI frame count （ CTFC ） and TIMI myocardial perfusion grade （ TMP ） were significantly better in intracoronary injection group than peripheral vein injection group and control group （ P 〈 0. 05） . All patients were followed up for 9 months, LVDd in intracoronary injection group was sig-nificantly lower than those in peripheral vein injection group and control group （ P 〈 0. 05 ） . LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group （P 〈 0. 05 ） . The incidence rate of MACE in mtracoronary injection group was significantly less than that in peripheral vein injection group and control group （ P 〈 0. 05 ） . There was no significantly difference between the peripheral vein injection group and 0.05）. Conclusion For NSTEMI patients with early PCI, intracoronary injection and peripheralintravenous injection of prostaglandin E1 can get a better myocardial microcirculatiing operation, and intracoronary injection can significantly reduce the incidence events.