非ST段抬高型心肌梗死患者介入治疗最佳时机选择与预后分析

Optimal timing and prognosis of interventional therapy for patients with non-ST-elevation myocardial infarction

目的探究非ST段抬高型心肌梗死(NSTEMI)患者介入治疗最佳时机。方法选取2012年4月~2016年4月于郑州大学第一附属医院收治的NSTEMI患者258例,均采取经皮冠状动脉介入术(PCI)治疗。根据介入时机不同分为早期PCI组(发病24 h内)136例和非早期PCI组(发病24 h后)122例。比较两组基线资料、再发心脏事件情况、TIMI分级、左室功能及心功能Killip分级情况。结果两组基线资料差异均无统计学意义(P>0.05)。出现再发心脏事件的患者中,早期PCI组血糖控制稳定的比例较低,血压控制稳定的比例较高。两组PCI术后TIMI血流分级差异有统计学意义(P<0.05),早期PCI组血流分级较高。PCI术后6个月,早期PCI组左室舒张末径(LVDd)小于非早期PCI组,左室射血分数(LVEF)高于非早期PCI组,差异均有统计学意义(P<0.05)。PCI术后早期PCI组心功能Killip分级优于非早期PCI组(P<0.05)。结论对于NSTEMI患者,早期PCI有利于恢复左室功能,但应根据患者血压及血糖控制情况具体选择手术时机。

Objective To investigate optimal timing of interventional therapy for patients with non-ST-elevation myocardial infarction(NSTEMI).Methods258patients with NSTEMI treated from Apr.2012to Apr.2014were selected and received percutaneous coronary intervention(PCI).They were divided into early PCI group(within24hours of onset,136patients)and non-early PCI group(after24hours of onset,122patients).Clinical data were compared between two groups.Results There was no significant difference in baseline data between two groups(P>0.05).In patients with recurrent cardiac events,the proportion of stable blood glucose control in the early PCI group was lower and the proportion of blood pressure control was higher than that in non-early PCI group(P<0.05).The thrombolysis in myocardial infarction(TIMI)flow grade and Killip level in early PCI group were higher than those in non-early PCI group(P<0.05).At six months after PCI,the left ventricular end diastolic dimension(LVDd)in early PCI group was lower than that in non-early PCI group,and the left ventricular ejection fraction(LVEF)in early PCI group was higher than that in non-early PCI group(P<0.05).Conclusion As for NSTEMI patients,early PCI is beneficial to the recovery of left ventricular function,but the timing of surgery should be selected according to the patients’blood pressure and glycemic control.