不同时间窗冠状动脉介入治疗对急性心肌梗死患者心功能及脑卒中发生情况的影响

The effect of different time window coronary intervention on the heart function and stroke in patients with acute myocardial infarction

目的:探讨急性心肌梗死(AMI)患者不同时间窗行经皮冠状动脉介入治疗(PCI)与术后发生脑卒中及心功能的相关性。方法:选取1362例行PCI术的AMI患者,根据术后是否发生脑卒中分为发生组(29例)和未发生组(1333例)。收集并比较两组患者的临床资料,采用单因素及Logistic回归分析术后脑卒中发生的危险因素;比较不同介入治疗时间患者心功能相关指标,采用Spearman相关分析法分析介入治疗时间与心功能指标的相关性。结果:介入治疗时间、术前Killip评级、N-末端脑利钠肽前体(NT-proBNP)水平是PCI术后发生脑卒中的危险因素。介入治疗时间≤6 h患者术后左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)小于介入治疗时间>6 h的患者[LVESD:(33.26±5.32)mm∶(36.13±5.41)mm;LVEDD:(48.56±6.23)mm∶(50.16±6.18)mm;均P<0.05],左室射血分数(LVEF)、左室短轴缩短率(FS)高于介入治疗时间>6 h的患者[LVEF:(63.49±4.58)%∶(52.37±4.74)%;FS:(31.51±5.31)%∶(27.97±5.69)%;均P<0.05]。介入治疗时间与术后LVESD、LVEDD呈正相关(r=0.623、0.646,P=0.031、0.035),与LVEF、FS呈负相关(r=-0.737、-0.705,P=0.023、0.029)。结论:尽早介入治疗可降低术后脑卒中发生率,改善心功能,提高预后。

Objective:To investigate the correlation between the occurrence of stroke,cardiac function,and different time window percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods:A total of 1362 patients with AMI who underwent PCI were selected and divided into the stroke group(n=29)and non-stroke group(n=1333)according to whether stroke occurred after the operation.The clinical data of the two groups were collected and compared.Univariate and logistic regression analyses were used to analyze the risk factors of postoperative stroke.The indexes about cardiac function were compared in patients underwent PCI at different time.Spearman correlation analysis was used to analyze the correlation between PCI time and cardiac function.Results:PCI time,preoperative Killip class,and N-terminal pro-brain natriuretic peptide(NT-proBNP)level were the influencing factors of stroke after PCI.Compared with patients with interventional treatment time>6 h,the postoperative left ventricular end-systolic diameter(LVESD)and left ventricular end-diastolic diameter(LVEDD)in those with interventional treatment time≤6 h were lower[LVESD:(33.26±5.32)mm vs.(36.13±5.41)mm;LVEDD:(48.56±6.23)mm vs.(50.16±6.18)mm;both P<0.05],while the left ventricular ejection fraction(LVEF)and fraction shortening(FS)were higher[LVEF:(63.49±4.58)%vs.(52.37±4.74)%;FS:(31.51±5.31)%vs.(27.97±5.69)%;both P<0.05].Interventional treatment time was positively correlated with postoperative LVESD and LVEDD(r=0.623,0.646,P=0.031,0.035),while negatively correlated with LVEF and FS(r=-0.737,-0.705,P=0.023,0.029).Conclusion:Early interventional treatment can reduce the incidence of postoperative stroke and improve heart function and prognosis.