ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗时应用单根指引导管的有效性与安全性

Effectiveness and safety of using a single guiding catheter in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

目的评估急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经桡动脉途径行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中依据术前检查结果,直接使用单根指引导管的有效性与安全性。方法连续入选2017年1月至2019年1月于汕头市第二人民医院住院,诊断为STEMI且具有急诊冠状动脉造影及PCI治疗指征的患者120例。用随机数字表法以1∶1随机分为试验组与对照组。对比两组门-球囊(door-to-balloon,D2B)时间、穿刺至球囊时间、住院时间及半年主要不良心血管事件(major adverse cardiac event,MACE)发生率等。结果试验组中的D2B时间[(65±15)min vs.(73±19)min,P=0.01]和穿刺至球囊时间[(18±10)min vs.(28±13)min,P<0.001]比对照组更短,差异有统计学意义。在试验组中,使用指引导管的数量显著低于对照组,差异有统计学意义(P<0.05)。30 d随访过程中,两组均有2例MACE发生,两组MACE发生率比较,差异无统计学意义(P>0.05)。结论依据术前检查的结果,直接使用单个指引导管在STEMI患者中行急诊PCI治疗能有效缩减D2B时间。

Objectives To evaluate the effectiveness and safety of using a single guiding catheter in patients with ST segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI)according topreoperative examination results.MethodsTotally 120 consecutive STEMI patients from January 2017 to January 2019 in The Second People’s Hospital of Shantou.The 120 patients were randomly divided into treatment group(n=60)andcontrol group(n=60).Differences of door-to-balloon(D2 B)duration,puncture-to-balloon duration,in-hospital du-ration and 30 days major adverse cardiovascular event(MACE)incidence rate between the two groups were compared.ResultsD2 B duration[(65±15)min vs.(73±19)min,P=0.01]and puncture-to-balloon duration[(18±10)min vs.(28±13)min,P<0.001]in treatment group were significantly shorter than those in control group.The total number of di-agnostic and guiding catheters of treatment group was significantly less than that of control group(P<0.05).During the30 d follow-up,both groups had 2 cases of MACE,and the difference of incidence of MACE between the two groupswas not significant(P>0.05).ConclusionsUsing a single guiding catheter in patients with STEMI undergoing PCI ac-cording to preoperative examination results can effectively reduce the D2 B duration.