急诊PCI冠脉无复流现象的机制及防治研究

Research on Mechanism and Prevention and Control of No Reflux Phenomenon of Emergency PCI Coronary Patients

目的探讨无复流发生的机制以及防治无复流相关的治疗措施。方法以2013年1月—2018年1月作为研究阶段,研究对象方便选取400例,均为进入该院就诊并接受PCI治疗的ST段抬高型心肌梗死(ST elevation myocardial infarction,STEMI)患者,在记录基本情况、相关化验检查的基础上记录术前相关药物使用情况,记录急诊PCI术中罪犯血管及治疗措施等,采用CTFC判断未出现无复流-慢血流现象,作为观察组,采用CTFC判断出现冠脉无复流-慢血流现象,作为对照组,分析术后无复流的主要影响因素。结果对照组糖尿病46例,观察组糖尿病93例,差异有统计学意义(P<0.05)。对照组CK-MB(409.86±89.75)IU/L、CK(1 693.52±536.34)IU/L、BNP(89.34±13.63)pg/m L、MPV(8.04±0.42)fl、肌钙蛋白(0.24±0.02)μg/L、WBC(6.37±0.22)×10~9/L、LDL(2.78±0.12)mmol/L、TG(1.04±0.11)mmol/L、UA(257.54±23.66)μmol/L与观察组CK-MB(739.97±184.73)IU/L、CK(3 416.14±739.82)IU/L、BNP(332.83±45.54)pg/m L、MPV(4.67±0.31)fl、肌钙蛋白(0.51±0.03)μg/L、WBC(12.04±0.09)×10~9/L、LDL(4.86±0.18)mmol/L、TG(3.45±0.33)mmol/L、UA(114.86±14.89)μmol/L差异有统计学意义(P<0.05)。两组罪犯血管差异无统计学意义(P>0.05)。两组的药物使用情况差异有统计学意义(P<0.05)。结论针对急诊PCI冠脉无复流患者需要在明确其发病机制的基础上采取针对性的治疗手段,通过联合用药可在一定程度上预防无复流现象。

Objective To study the mechanism and prevention and control of no reflux phenomenon of emergency PCI coronary patients. Methods 400 cases of patients with ST elevation myocardial infarction admitted and treated in our hospital from January 2013 to January 2018 were convenient selected, and the usage of related drugs was recorded on the basis of recording the basic condition and related biochemical examination, and the criminal blood vessels and treatment measures in the emergency PCI surgery were recorded, and the observation group were the patients without reflux determined by the CTFC, while the control group were the patients with reflux, and the main influencing factors were analyzed. Results There were 46 cases with diabetes in the control group and 93 cases with diabetes in the observation group, and the difference was obvious, with statistical significance（P〈0.05）, and the differences in the CK-MB, CK, BUP, MPV, troponin, WBC, LDL, TG,UA between the control group and the observation group were obvious, [（409.86 ±89.75） IU/L,（1 693.52 ±536.34） IU/L,（89.34±13.63） pg/m L,（8.04±0.42） fl,（0.24±0.02）μg/L,（6.37±0.22）×10~9/L,（2.78±0.12） mmol/L,（1.04±0.11） mmol/L,（257.54±23.66）μmol/L vs（739.97 ±184.73） IU/L,（3 416.14 ±739.82）IU/L,（332.83 ±45.54） pg/m L,（4.67 ±0.31） fl,（0.51 ±0.03）μg/L,（12.04±0.09）×10~9/L,（4.86±0.18） mmol/L,（3.45±0.33） mmol/L,（114.86±14.89） μmol/L], with statistical significance（P〈0.05）,and the difference in the culprit vessel between the two groups was not statistical significance（P〈0.05）. The difference in drug use between the two groups was statistically significant（P〈0.05）. Conclusion We should use the targeted treatment means of emergency PCI coronary patients on the basis of making the onset mechanism clear, and the combined medication can prevent the phenomenon of no reflux to a certain degree.