冠状动脉介入术后射血分数中间范围患者特点的临床调查

Clinical investigation of the characteristics of patients with median ejection fraction after coronary intervention

目的观察冠状动脉(冠脉)介入术后射血分数中间范围患者临床特点及预后。方法选择2016年1月至2017年12月于中国人民解放军陆军第81集团军医院心内科接受急诊冠脉介入术患者180例,按术后超声心动检查的左室射血分数(LVEF)值分为rEF组60例,mrEF组60例,pEF组60例。记录患者一般资料、入院48 h内超声心动检查的LVEF值、血常规、生化检验;术前术后的TIMI血流情况、ST段变化;术前病变血管支数;术后心肌灌注分级(TMP)、心肌blush分级(MBG)等情况。结果rEF组患者比mrEF组在术后TIMI血流改善快、IRA开通时间快、曝光时间短(P<0.05)。mrEF组患者比pEF组在术后TIMI血流改善快、IRA开通时间快、曝光时间短,且血管病变支数以1支为多见(P<0.05)。rEF组患者在术后TIMI血流改善、IRA开通时间、血管病变支数、曝光时间等方面优于pEF组(P<0.05)。rEF组在术后出现TIMI血流3级、MBG3级、TMP3级、ST段回落(STR)以及术后院内病死情况的患者人数优于mrEF组和pEF组(P<0.05)。mrEF组在术后出现MBG3级、TIMI血流3级、TMP3级、ST段回落(STR)情况的患者人数比例优于pEF组(P<0.05)。rEF组在术后改善SNT-pro-BNP均值、CK-MB、谷丙转氨酶等化验结果优于mrEF组和pEF组(P<0.05)。结论PCI后的mrEF患者疗效优于pEF组但又不及rEF组,且术后院内病死情况mrEF组和pEF组无区别。

Objective To observe the clinical characteristics and prognosis of patients with intermediate ejection fraction after coronary intervention.Methods 180 patients who underwent emergency coronary intervention in the Department of Cardiology,251 Hospital of PLA from January 2016 to December 2017 were selected and divided into rEF group(60 cases),mrEF group(60 cases)and pEF group(60 cases)according to the LVEF value of postoperative echocardiography.General information of patients,LVEF value of echocardiography within 48 hours of admission,blood routine,biochemical examination,TIMI blood flow before and after surgery,ST segment changes,number of diseased vessels before surgery,myocardial perfusion grade(TMP),myocardial blush grade(MBG)after surgery,etc.were recorded.Results TIMI blood flow improved faster,IRA opened faster and exposure time shorter in rEF group than in mrEF group(P<0.05).In the MREF group,TIMI blood flow improved faster than in the pEF group,IRA was opened faster,exposure time was shorter,and the number of vascular lesion branches was more common in the MREF group than in the pEF group(P<0.05).The rEF group was significantly superior to the pEF group in terms of improvement of TIMI blood flow,opening time of IRA,number of vessel lesions and exposure time after operation(P<0.05).The number of patients with TIMI grade 3,MBG3,TMP3,ST-segment depression(STR)and in-hospital mortality after surgery in rEF group was significantly higher than that in mrEF group and pEF group(P<0.05).The proportion of patients with MBG3,TIMI flow grade 3,TMP3 and ST-segment depression(STR)in the mrEF group was higher than that in the pEF group(P<0.05).The rEF group improved the mean SNT-pro-BNP,CK-MB,glutamic-pyruvic transaminase and other experimental results after surgery than the mrEF group and the pEF group(P<0.05).Conclusion The curative effect of patients with mrEF after PCI is better than that of patients with pEF but not better than that of patients with rEF,and there is no difference between patients with mrEF and patients with pEF in terms of in-hospital mortality after PCI.