胸阻抗法心排血量比较直接PCI和延迟PCI对急性ST段抬高型心肌梗死患者心功能的影响

Comparison of the Effect of Primary PCI and Delayed PCI on the Heart Function of Patients with ST-segment Elevation Myocardial Infarction by Thoracic Impedance Method for Testing Cardiac Output

目的:采用胸阻抗法心排血量检测和比较直接和延迟经皮冠状动脉介入术(PCI)对急性ST段抬高型心肌梗死(STEMI)患者心功能的影响。方法:收集2016年1月-2018年6月于解放军南部战区海军第一医院收治的114例STEMI患者完整资料,分为直接PCI组48例,延迟PCI组40例,对照组(未行任何再灌注治疗)26例。采用胸阻抗法心排血量检测各组患者治疗后3天、6个月的每搏输出量(SV)、心指数(CI)、左心收缩力指数(CTI)、射血分数(EF)等心功能参数,并随访患者6个月内因心力衰竭再住院的情况。结果:治疗后6个月,直接PCI组和延迟PCI组SV、CI、CTI、EF均显著高于对照组,且直接PCI组SV、CTI、EF明显高于延迟PCI组,各组间差异具有统计学意义(P<0.05)。直接PCI组和延迟PCI组6个月内因心力衰竭再住院分别为2.08%和5%,均显著低于对照组(19.23%),差异具有统计学意义(P<0.05)。结论:直接和延迟PCI均能改善STEMI患者中远期心功能,且直接PCI效果更为显著。

Objective: To compare the effect of primary PCI and delayed PCI on the heart function of patients with ST-segment elevation myocardial infarction(STEMI) by thoracic impedance method for testing cardiac output. Methods: 114 patients with STEMI were selected in the No 1 Hospital of Naval Force of Southern Theater Command of PLA from January 2016 to June 2018, they were divided into the primary PCI group(n=48), delayed PCI group(n=40) and control group without receiving any coronary artery reperfusion(n=26). The stroke volume(SV), cardiac index(CI), cardiac contractility index(CTI), ejection fraction(EF) were measured at 3 days and 6 months after therapy were detected by using thoracic impedance method, and the rehospitalization due to heart failure events in each group in 6 months were evaluated. Results: At 6 months after therapy, the SV, CI, CTI, EF were higher in the primary PCI group and delayed PCI groupthan these in control group, and SV, CTI, EF in primary PCI group were higher than these in delayed PCI group(P<0.05). The rehospitalization rate due to heart failure in primary PCI group and delayed PCI group were remarkably lower than these of control group(P<0.05). Conclusions: Both primary and delayed PCI can improve the heart function in medium and long term in patiens of STEMI, and the primary PCI is more effective.