增强型体外反搏对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗后冠状动脉血流的短期效应

Short-term effect of enhanced external counterpulsation on coronary flow in patients with acute ST-segment elevation myocardial infarction after primary PCI

目的 探讨增强型体外反搏（enhanced external counterpulsation，EECP）对急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后血流的短期效应。方法 收集我院（2017年1月至2018年1月）诊断为急性ST段抬高型心肌梗死并经桡动脉行急诊PCI的患者70例，分为EECP组和对照组。两组分别给予反搏治疗或气囊包裹30 min，记录两组患者的主动脉舒张压（DBP）、主动脉收缩压（SBP）和心率（HR）的变化；测定两组患者治疗前后血清脑利钠钛前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白I（cTnI）的水平，并计算冠状动脉血流校正的TIMI帧数（corrected TIMI frame count，cTFC），观察两组患者在治疗过程中出现的不良反应和并发症。结果 在EECP组，与PCI术后即刻相比较，反搏30 min后的主动脉舒张压明显升高，由（70.7＆#177;9.1）mm Hg升至（80.5＆#177;9.0）mm Hg，收缩压明显降低，由（119.1＆#177;10.2）mm Hg降至（111.6＆#177;9.6）mm Hg，差异有统计学意义，但在停止反搏治疗后均恢复至原来的水平，而在这一过程中患者的心率没有明显的改变，同时患者的cTFC由35.1＆#177;18.7降至21.6＆#177;3.0，NT-proBNP由（5197.7＆#177;2018.6）pg/ml降至（3359.4＆#177;1522.8）pg/ml，差异均有统计学意义。而在对照组，上述指标在处理过程后均没有明显的变化。两组患者治疗前后血清CK-MB和cTnI均明显升高，达到了统计学差异，但两组治疗后相比则没有明显的统计学差异，安全性也没有明显的差异。结论 EECP对急性ST段抬高型心肌梗死患者行急诊PCI后的血流动力学短期内有明显的改善作用，提高舒张压、降低收缩压，减少冠状动脉慢血流，改善心功能，是一项安全有效的治疗手段。

Objective To observe the short-term effect of enhanced external counterpulsation（EECP） on coronary flow in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention（PCI）. Methods A total of 70 patients from our hospital between January 2017 and January 2018with acute ST-segment elevation myocardial infarction, who underwent primary PCI via radial artery, were divided into EECP group and control group. In EECP group, the patients were treated with EECP for 30 min, and in control group, the patients were given cuffs wrapped for 30 min. Aorta diastolic blood pressure（DBP）, systolic blood pressure（SBP）, and heart rate（HR） in two groups were recorded; the levels of serum NT-proBNP, CK-MB and cTnI were detected before and after treatment, the corrected TIMI frame count（cTFC） were also calculated, and the adverse reactions and complications during treatment were observed. Results In EECP group, compared with immediate after PCI, DBP after treatment for 30 min was elevated, from （70.7＆#177;9.1）mm Hg to （80.5＆#177;9.0）mm Hg, SBP was decreased, from （119.1＆#177;10.2）mm Hg to （111.6＆#177;9.6）mm Hg, but both returned back to original level, and the HR didn’t change during the period, meanwhile, cTFC decreased from 35.1＆#177;18.7 to 21.6＆#177;3.0, and NT-proBNP decreased from（5197.7＆#177;2018.6）pg/ml to （3359.4＆#177;1522.8）pg/ml, both improved significantly after EECP treatment. However, in control group, all the indexes were not changed significantly before and after treatment. In two groups, the levels of CK-MB and cTnI both rose significantly, however, there is no change between two groups after treatment. In the aspect of safety, there were no MACE, such as bleeding, stroke, reinfarction and death happened in two groups. Conclusion EECP could improve the short-term hemodynamics after primary PCI in patients with ST-segment elevation myocardial infarction, increase DBP, decrease SBP, reduce the occurrence of slow flow, and improve heart function, is a safe and effective treatment.