PCI联合临时起搏器植入治疗AMI并缓慢性心律失常的疗效

Therapeutic effect of PCI combined temporary pacemaker implantation on patients with AMI complicated bradyarrhythmia

目的:研究PCI联合临时心脏起搏器植入对急性心肌梗死(AMI)合并缓慢性心律失常(BA)的疗效。方法:本院2016~2019年收治的104例AMI+BA患者被随机均分为单纯PCI组和联合治疗组(在单纯PCI组基础上接受临时心脏起搏器植入)。治疗前和7d后,检测比较两组LVEDd、LVESd、LVEF、心输出量(CO)、血清脑钠肽(BNP)、肌红蛋白(Mb)和心肌肌钙蛋白I(cTnI)水平,心血管不良事件发生率,以及随访3个月时的中国心血管患者生活质量评定问卷(CQQC)评分。结果:与单纯PCI组治疗7d后比较,联合治疗组LVEDd[(54.79±5.49)mm比(49.98±4.46)mm]、LVESd[(44.36±4.70)mm比(42.00±625)mm]、血清BNP[(328.11±17.44)pg/ml比(155.01±16.14)pg/ml]、cTnI[(5.02±0.69)μg/ml比(3.21±0.64)μg/ml]、Mb水平显著降低,LVEF[(44.90±3.16)%比(51.29±4.46)%]、CO[(4.05±1.06)L·min^-1·m^-1比(4.72±1.15)L·min^-1·m^-1]显著升高,P<0.05或<0.01。联合治疗组术后心血管不良事件发生率显著低于单纯PCI组(7.69%比32.69%),P=0.001。与单纯PCI组随访3个月时比较,联合治疗组CQQC各维度评分和总分[(91.26±8.36)分比(105.56±8.29)分]均显著升高,P均<0.01。结论:PCI联合临时起搏器植入治疗AMI合并缓慢性心律失常患者,可更显著地改善心功能,减轻心肌损伤程度,提高预后生活质量。

Objective:To study therapeutic effect of PCI combined temporary pacemaker implantation(TPI)on patients with acute myocardial infarction(AMI)complicated bradyarrhythmia(BA).Methods:A total of 104 AMI+BA patients treated in our hospital from Jan 2016 to Jan 2019 were randomly and equally divided into pure PCI group and combined treatment group(received TPI based on pure PCI group).LVEDd,LVESd,LVEF,cardiac output(CO),serum levels of brain natriuretic peptide(BNP),myoglobin(Mb)and cardiac troponin I(cTnI)before and 7d after treatment,incidence rate of adverse cardiovascular events,and score of Chinese questionnaire of quality of life in patients with cardiovascular disease(CQQC)after three-month follow-up were measured and compared between two groups.Results:Compared with pure PCI group after 7d treatment,there were significant reductions in LVEDd[(54.79±5.49)mm vs.(49.98±4.46)mm],LVESd[(44.36±4.70)mm vs.(42.00±625)mm],serum levels of BNP[(328.11±17.44)pg/ml vs.(155.01±16.14)pg/ml],cTnI[(5.02±0.69)μg/ml vs.(3.21±0.64)μg/ml],Mb and significant rise in LVEF[(44.90±3.16)%vs.(51.29±4.46)%]and CO[(4.05±1.06)L·min^-1·m^-1 vs.(4.72±1.15)L·min^-1·m^-1]in combined treatment group,P<0.05 or<0.01.Incidence rate of adverse cardiovascular events after operation in combined treatment group was significantly lower than that of pure PCI group(7.69%vs.32.69%),P=0.001.Compared with pure PCI group after three-month follow-up,there were significant rise in each dimension score and total score of CQQC[(91.26±8.36)scores vs.(105.56±8.29)scores]in combined treatment group,P<0.01 all.Conclusion:PCI combined TPI possesses significant therapeutic effect on patients with AMI complicated bradyarrhythmia.It can significantly improve cardiac function,relieve myocardial injury,and improve prognosis and quality of life in these patients.