急诊补救PCI治疗在凉山地区急性心肌梗死中的应用及临床效果分析

Application and Clinical Effect Analysis of Emergency Remedial PCI in Acute Myocardial Infarction in Liangshan Area

目的:调查急诊补救PCI治疗在凉山地区急性心肌梗死(acute myocardial infarction,AMI)中的应用,并分析其临床效果。方法:选取西昌市人民医院心血管内科2018年6月-2019年5月收治的237例AMI患者作为研究对象。根据治疗方式的不同将其分为直接PCI组(n=122)、延迟PCI组(n=67)和补救PCI组(n=48)。直接PCI组直接实施PCI治疗,延迟PCI组接受静脉溶栓后行择期PCI治疗,补救PCI组则是接受静脉溶栓后未再通行补救PCI治疗。比较三组梗死血管再通情况、心功能、不良心脑血管事件(MACCE)发生率及预后生存情况。结果:治疗后,三组IRA血流TIMI分级均较治疗前上升。其中补救PCI组IRA再通率为97.92%,高于直接PCI组的95.08%和延迟PCI组的94.03%,但三组比较差异无统计学意义(P>0.05)。治疗后1个月,三组LVEF、LVFS、LVEDD和LVESD比较差异无统计学意义(P>0.05)。治疗后6个月,三组心功能指标均较治疗后1个月有所改善,差异有统计学意义(P<0.05)。治疗后6个月,补救PCI组LVEF、LVFS水平高于直接PCI组及延迟PCI组,差异有统计学意义(P<0.05)。随访6个月,三组MACCE发生率比较差异无统计学意义(P>0.05)。生存曲线分析发现,补救PCI组生存率为95.83%,高于直接PCI组的91.80%和延迟PCI组的91.05%,但三组比较差异无统计学意义(P>0.05)。结论:当凉山地区AMI患者溶栓治疗效果不佳时,可立即转至笔者所在医院实施补救PCI治疗,其IRA再通率高,可改善患者心功能,从而促进远期预后。

Objective:To investigate the application of emergency remedial PCI in acute myocardial infarction(AMI)in Liangshan area and analyze its clinical effect.Method:A total of 237 patients with AMI admitted in the department of cardiovascular medicine of our hospital from June 2018 to May 2019 were selected as the study subjects.According to the different treatment methods,the patients were divided into the direct PCI group(n=122)and the delayed PCI group(n=67)and the remedial PCI group(n=48).The direct PCI group was treated with PCI directly,the delayed PCI group was treated with elective PCI after intravenous thrombolysis,and the remedial PCI group was treated with remedial PCI after intravenous thrombolysis without recanalization.The infarct recanalization,cardiac function,incidence of MACCE,and survival were compared among the three groups.Result:After treatment,theTIMI grading of IRA blood flow in the three groups were increased compared with those before treatment.The IRA recirculation rate of the remedial PCI group was 97.92%,which was higher than 95.08%of the direct PCI group and 94.03%of the delayed PCI group,but there was no significant difference among the three groups(P>0.05).One month after treatment,there were no significant differences in LVEF,LVFS,LVEDD and LVESD among the three groups(P>0.05).At 6 months after treatment,cardiac function indexes of the three groups were improved compared with those 1 month after treatment,the differences were statistically significant(P<0.05),the levels of LVEF and LVFS in the remedial PCI group were higher than those in the direct PCI group and the delayed PCI group(P<0.05).At 6 months after treatment,the levels of LVEF and LVFS in the remedial PCI group were higher than those in the direct PCI group and the delayed PCI group,the differences were statistically significant(P<0.05).After 6 months follow-up,there was no significant difference in the incidence of MACCE among the three groups(P>0.05).Survival curve analysis showed that the survival rate of the remedial PCI group was 95.83%,which was higher than 91.80%of the direct PCI group and 91.05%of the delayed PCI group,but there was no significant difference among the three groups(P>0.05).Conclusion:When the thrombolytic effect for AMI patients in Liangshan area is not good,remedial PCI treatment should be immediately carried out with transferring to our hospital,which has a high IRA recanalization rate and can improve the patients’cardiac function,thus promoting the long-term prognosis.