直接PTCA加支架置入术对急性心肌梗死患者的近期疗效及对QTd的影响

Short-term therapeutic effect of direct PTCA combined stenting on patients with acute myocardial infarction and its influence on QTd

目的:分析直接经皮冠状动脉内腔成形术(PTCA)加支架置入术对急性心肌梗死(AMI)患者的近期疗效及对QT离散度(QTd)的影响。方法:回顾性分析2016年1月～2017年1月院内接受治疗的100例AMI患者的临床资料。根据治疗方式的不同,患者被分为PTCA组(59例,接受PTCA联合支架置入术)和溶栓组(51例,接收重组组织型纤溶酶原激活剂溶栓治疗),疗程为3周。比较两组患者的临床疗效、QTd、校正QT离散度(QTcd)及预后。结果:与溶栓组比较,PTCA组住院期和随访期的血管再通率和生存率均显著升高,而并发症发生率则显著降低,P<0.05或<0.01。治疗后,PTCA组的QTd[(40.26±10.33)ms比(56.79±12.57)ms]和QTcd[(42.28±11.57)ms比(59.33±10.18)ms]均显著低于溶栓组(P<0.01);且PTCA组的护理满意度和护理依从性也均显著高于溶栓组(100%比88.24%,98.31%比84.31%),P均<0.01。结论:直接PTCA加支架术治疗AMI患者,可显著提高患者的血管再通率和生存率,降低患者的并发症发生率,改善患者的QTd,结合围术期护理模式,还可显著提高患者的护理满意度和依从性,值得广泛应用和推广。

Objective: To analyze short-term therapeutic effect of direct percutaneous transluminal coronary angioplasty (PTCA) combined stenting on patients with acute myocardial infarction (AMI) and its influence on QT dispersion (QTd). Methods: Clin data of 100 AMI patients treated in our hospital from Jan 2016 to Jan 2017 were retrospectively analyzed. According to therapeutic method, patients were divided into PTCA group (n=59, received PTCA combined stenting) and thrombolysis group (n=51, received recombinant tissue type plasminogen activator treatment), both groups were treated for 3 weeks. Clin therapeutic effect, QTd, corrected QTd (QTcd) and prognosis were compared between two groups. Results: Compared with thrombolysis group, there were significant rise in recanalization rate and survival rate, and significant reduction in incidence rate of complications in PTCA group during hospitalization and follow-up, P <0.05 or <0.01. Compared with thrombolysis group after treatment, there were significant reductions in QTd[(56.79±12.57)ms vs.(40.26±10.33)ms]and QTcd [(59.33±10.18)ms vs.(42.28±11.57)ms], and significant rise in nursing satisfaction (88.24% vs. 100%) and nursing compliance (84.31% vs. 98.31%) in PTCA group, P <0.01 all. Conclusion: Direct PTCA combined stenting can significantly improve recanalization rate and survival rate, reduce incidence rate of complications and improve QTd in AMI patients. When combined with perioperative nursing mode, it can also significantly improve nursing satisfaction and compliance in these patients, which is worth application and extension.