缺血后适应联合急诊PCI对急性ST段抬高性心肌梗死患者预后的影响

Clinical study of ischemic postconditioning combined with emergency PCI on prognosis of patients with acute ST segment elevation myocardial infarction

目的探讨应用缺血后适应方法联合急诊PCI对急性ST段抬高性心肌梗死患者(STIMI)预后的影响。方法将就诊于新乡市中心医院2018年2月至2019年1月的STIMI患者共103例随机分为干预组及对照组,对照组采用常规PCI手术,干预组在对照组的治疗基础上给予患者缺血后适应干预疗法,比较两组患者出院时心肌标志物,出院后12个月时的心功能学指标及心血管事件(MACE)发生率。结果两组患者出院时干预组患者血清肌钙蛋白(CTnI)、磷酸激酶(CK)及磷酸激酶同Ⅰ酶(CKMB)均优于对照组,差异有统计学意义(P<0.05),两组患者乳酸脱氨酶(LDH)比较差异无统计学意义(P>0.05);出院12个月后两组患者心功能指标,干预组左室舒张末期容积(LVEDD)、左室收缩末期容积(LVESD)及左室射血分数(LVEF)水平较对照组改善更明显,差异有统计学意义(P<0.05)。出院12个月后回访心血管事件显示,干预组梗死后心绞痛、心肌再梗死、心功能不全、心源性休克较对照组比较差异均有统计学意义(P<0.05),心源性死亡发生率两组(干预组2.0%,对照组3.8%)差异无统计学意义(P>0.05)。结论缺血后适应方法联合急诊PCI能够有效改善急性ST段抬高性心肌梗死(STIMI)患者的预后,降低并发症,具有较强的推广价值。

Objective To investigate the effect of ischemic postconditioning combined with emergency PCI on the prognosis of patients with acute ST segment elevation myocardial infarction(STIMI).Methods A total of 103 patients with STIMI in our hospital from February 2018 to January 2019 were randomly divided into intervention group and control group.The control group was treated with conventional PCI,while the intervention group was treated with ischemic postconditioning intervention based on the treatment of the control group.The myocardial markers at discharge,cardiac function indexes and incidence of cardiovascular events(MACE)at 12 months after discharge were compared between the two groups.Results The cTnI,CK and CKMB of the intervention group were better than those of the control group at discharge,the difference was statistically significant(P<0.05),and the LDH of the two groups was not statistically significant(P>0.05);After 12 months of discharge,the cardiac function indexes of the two groups,LVEDd,LVESD and LVEF of the intervention group were improved more significantly than those of the control group,the difference was statistically significant(P<0.05).The cardiovascular events in the follow-up 12 months after discharge showed that there were significant differences in angina pectoris,myocardial reinfarction,cardiac insufficiency and cardiogenic shock between the intervention group and the control group(P<0.05),but there was no significant difference in the incidence of cardiogenic death between the two groups(P>0.05).Conclusion Ischemic postconditioning combined with emergency PCI can effectively improve the prognosis of patients with acute ST segment elevation myocardial infarction and reduce complications,which has a strong promotional value.