急性ST段抬高型心肌梗死患者PCI术后不同预后患者凝血功能的研究

Study on coagulation function of patients with acute ST elevation myocardial infarction treated by PCI

目的:比较急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后不同预后患者的凝血功能。方法:选取PCI治疗的451例急性STEMI患者为研究对象,结合治疗后Killip心功能分级及患者死亡情况对其进行分组,其中Killip心功能分级为Ⅰ级、Ⅱ级者纳入预后良好组(n=364),Killip心功能分级为Ⅲ级、Ⅳ级或死亡患者纳入预后不良组(n=87),比较两组患者术前实验室生化指标、心电图及超声检查结果以及手术前后凝血功能指标。结果:预后不良组中合并糖尿病患者所占比例高于预后良好组(P<0.05)。术前、预后不良组患者的血钾、血氮、血肌酐、血尿酸以及空腹血糖均高于预后良好组(P<0.05)。术前及术后,预后不良组凝血酶原时间(TT)、部分凝血酶原时间(APTT)及D-二聚体(D-D)值均高于预后良好组(P<0.05)。结论:急性ST段抬高型心肌梗死患者行PCI术后预后情况可能会受到凝血功能的影响。

Objective:To compare the coagulation function of patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:451 patients with acute ST segment elevation myocardial infarction who were treated by PCI were selected as the study objects,according to the classification of Killip's cardiac function and the death of patients,the patients with Killip's cardiac function classified as grade Ⅰ and Ⅱ were included in the group with good prognosis(n=364),the patients with Killip's cardiac function classified as grade Ⅲ and Ⅳ or death were included in the group with poor prognosis(n=87),the biochemical indexes,ECG and ultrasonic examination results before operation and coagulation function indexes after operation were compared between the two groups.Results:The proportion of patients with diabetes in poor prognosis group was higher than that in good prognosis group(P<0.05).Before operation,the blood potassium,blood nitrogen,blood creatinine,blood uric acid and fasting blood glucose in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Before and after operation,the values of TT,APTT and D-D in poor prognosis group were higher than those in good prognosis group(P<0.05).Conclusion:The prognosis of patients with acute ST segment elevation myocardial infarction after PCI may be affected by coagulation function.