溶栓时间对急性ST段抬高型心肌梗死患者手术疗效及不良事件的影响

Effects of Thrombolysis Time on Surgical Efficacy and Adverse Events in Patients With Acute ST-Segment Elevation Myocardial Infarction

目的探讨溶栓时间对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者手术疗效及不良事件的影响。方法采用回顾性研究方法,以76例STEMI患者为研究对象,两组患者溶栓后均经冠脉造影确认犯罪血管并对其实施冠状动脉介入术(Percutaneous coronary intervention,PCI),根据溶栓时间的不同,将患者分为两组,发病6h内溶栓患者分为A组(n=40),发病6~12h后溶栓患者分为B组(n=36),对比两组患者术后左心室舒张末期内径(Left ventricular end diastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)和左心室射血分数(Left ventricular ejection fraction,LVEF)]恢复情况,血管再通率,不良心血管事件(Major adverse cardiovascular events,MACE)发生率。结果两组患者LVEDD和LVESD均下降,LVEF均上升,A组心功能恢复显著优于B组(P<0.05);两组患者术后血管再通率对比,A组再通率87.5%显著高于B组55.6%(P<0.05);两组MACE发生率对比,A组发生率5%低于B组13.9%,差异无统计学意义(P>0.05)。结论溶栓时间越早,越有利于STEMI患者的心功能恢复,提高血管再通率,降低MACE的发生。

Objective To investigate the effects of thrombolysis time on surgical efficacy and adverse events in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Using a retrospective research method,76 STEMI patients were set as the research subjects.After thrombolysis,both groups of patients were given coronary angiography to confirm the culprit vessels and performed percutaneous coronary intervention(PCI).The patients were divided into two groups according to the different thrombolysis time.Patients with thrombolysis within 6 h of onset were selected as group A(n=40),and patients with thrombolysis within 6 h to 12 h of onset were set as group B(n=36).The left ventricular end-diastolic dimension(LVEDD),left ventricular endsystolic dimension(LVESD)and left ventricular ejection fraction(LVEF)],vascular recanalization rate and incidence rate of major adverse cardiovascular events(MACE)were compared between the two groups after surgery.Results The LVEDD and LVESD of the two groups were decreased while the LVEF was increased.The recovery status of cardiac function of LVEDD [(53.22±4.88)mm VS(57.24±4.96)mm],LVEF [(40.13±4.05)mm VS(45.86±4.27)mm] and LVEF [(65.15±5.25)% VS(57.95±5.48)%] in group A were significantly better than those in group B(P<0.05).Comparison of postoperative vascular recanalization rate between the two groups showed that the recanalization rate of group A was significantly higher than that of group B(87.5% VS 55.6%)(P<0.05).The incidence rate of MACE of group A was lower than that of group B(5% VS 13.9%)(P>0.05).Conclusion The earlier the thrombolysis time,the better the recovery of cardiac function in STEMI patients,the higher the vascular recanalization rate,and the lower the incidence of MACE.