改良PCI方案对老年STEMI患者的心功能及围术期不良事件的影响

Influence of modified PCI scheme on cardiac function and perioperative adverse events in aged STEMI patients

目的:研究改良经皮冠状动脉介入治疗(PCI)方案对老年ST段抬高型心肌梗死(STEMI)患者心功能及围术期不良事件的影响。方法:我院的115例老年STEMI患者被分为常规PCI组(接受常规PCI方案,60例)和改良PCI组(接受改良PCI方案,55例)。比较两组门诊-首次球囊扩张时间(D2B)、首次医疗接触-球囊扩张时间(FMC2B)、手术时间、X线辐射时间、造影剂用量、心率、LVEF、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、心输出量(CO)、每搏输出量(SV)及围术期不良事件发生率。结果:与常规PCI组比较,改良PCI组D2B[(72.63±11.09)min比(63.22±7.38)min]、FMC2B[(19.86±3.92)min比(15.03±2.75)畅min]、手术时间[(33.82±6.07)min比(24.19±4.24)min]、X线辐射时间[(11.34±2.08)min比(7.19±1.73)min]、造影剂用量[(92.41±12.53)ml比(75.62±8.44)ml],术后1个月LVEDV[(105.24±13.63)ml比(93.42±12.07)ml]、LVESV[(47.27±7.31)ml比(41.08±6.28)ml]均显著降低,LVEF[(51.94±7.88)%比(57.94±6.32)%]、CO[(5.79±1.03)L/min比(6.32±0.88)L/min]、SV[(80.53±13.09)ml比(88.41±10.26)ml]均显著升高(P均<0.01)。改良PCI组围术期不良事件发生率显著低于常规PCI组(12.73%比28.33%,P=0.040)。结论:改良PCI方案可显著缩短老年STEMI患者治疗时间,改善心功能,降低术后不良事件发生率。

Objective:To study the influence of modified percutaneous coronary intervention(PCI)scheme on cardiac function and perioperative adverse events in aged patients with ST-segment elevation myocardial infarction(STEMI).Methods:A total of 115 aged STEMI patients were divided into routine PCI group(received routine PCI scheme,n=60)and modified PCI group(received modified PCI scheme,n=55).Door-to-balloon(D2B),first medical contact to balloon(FMC2B),operation time,X-ray radiation time,contrast agent dosage,heart rate,LVEF,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),cardiac output(CO)and stroke volume(SV)before and one month after PCI and incidence rate of perioperative adverse events were observed and compared between two groups.Results:Compared with routine PCI group,there were significant reductions in D2B[(72.63±11.09)min vs.(63.22±7.38)min],FMC2B[(19.86±3.92)min vs.(15.03±2.75)min],operation time[(33.82±6.07)min vs.(24.19±4.24)min],X-ray radiation time[(11.34±2.08)min vs.(7.19±1.73)min],contrast agent dosage[(92.41±12.53)ml vs.(75.62±8.44)ml],one month after PCI the LVEDV[(105.24±13.63)ml vs.(93.42±12.07)ml]and LVESV[(47.27±7.31)ml vs.(41.08±6.28)ml],and significant rise in LVEF[(51.94±7.88)%vs.(57.94±6.32)%],CO[(5.79±1.03)L/min vs.(6.32±0.88)L/min]and SV[(80.53±13.09)ml vs.(88.41±10.26)ml]in modified PCI group(P<0.01 all).Incidence rate of perioperative adverse events in modified PCI group was significantly lower than that of routine PCI group(12.73%vs.28.33%,P=0.040).Conclusion:Modified PCI scheme can significantly shorten treatment time,improve cardiac function and reduce incidence rate of postoperative adverse events in aged STEMI patients.