不同时间窗PCI术对AMI患者的疗效及微循环灌注的影响

Clinical efficacy of percutaneous coronary intervention in different time windows in the treatment of acute myocardial infarction and its effect on microcirculation perfusion

目的探究不同时间窗冠脉介入治疗(PCI)对急性心肌梗死(AMI)患者的疗效及微循环灌注的影响。方法选取2020年5月至2021年5月佛山市南海区第四人民医院收治的60例拟行PCI治疗的AMI患者作为研究对象,根据患者发病至首次医疗接触时间(S-to-FMC),以心肌缺血抢救的黄金120 min为分组节点,将S-to-FMC≤120 min患者纳入研究组,而S-to-FMC>120 min患者纳入对照组,每组30例。比较两组患者PCI治疗的总有效率,并采用心肌声学造影(MCE)对两组患者左心室心肌节段微循环进行定量分析,对比两组患者MCE灌注参数[心肌血容量(A值)、心肌平均血流速度(β值)、局部心肌血流量(A×β值)]以及冠状动脉狭窄程度。结果研究组患者PCI治疗的总有效率为93.33%,明显高于对照组的76.67%,差异具有统计学意义(P<00.05);研究组患者MCE灌注参数A值、β值及A×β值分别为(3.32±1.27)dB、(2.42±0.98)m/s、(4.52±1.08)dB/s,明显高于对照组的(1.75±0.45)dB、(1.83±0.29)m/s、(2.31±0.42)dB/s,差异均具有统计学意义(P<0.05);研究组患者冠脉狭窄程度在0~49%、50%~69%之间心肌节段数量分别为137个、99个,明显高于对照组的87个、71个,差异均具有统计学意义(P<0.05),而两组患者冠脉狭窄程度在70%~89%之间的心肌节段数量比较差异无统计学意义(P>0.05);冠脉狭窄程度≥90%时,研究组患者的心肌节段数量29个,明显低于对照组的77个,差异具有统计学意义(P<0.05)。结论AMI患者发病后2 h行PCI术能明显改善患者的微循环灌注情况,治疗效果更好,具有临床推广应用价值。

Objective To explore the clinical efficacy of percutaneous coronary intervention(PCI)in different time windows in the treatment of acute myocardial infarction(AMI)and its effect on microcirculation perfusion.Methods Sixty AMI patients who were treated in the Fourth People's Hospital of Nanhai District,Foshan City from May 2020 to May 2021 were selected as the research objects.According to the time of symptom onset-first medical con-tact(S-to-FMC),using the golden 120 min of myocardial ischemia rescue as the grouping node,patients with S-to-FMC≤120 min were included in the study group,while patients with S-to-FMC>120 min were included in the con-trol group,with 30 patients in each group.The total effective rate of PCI was compared between the two groups,and the left ventricular regional microcirculation of the two groups was quantitatively analyzed by myocardial contrast echocar-diography(MCE).The MCE perfusion parameters[myocardial blood volume(A value),myocardial mean blood flow ve-locity(βvalue),and regional myocardial blood flow(A×βvalue)]and the degree of coronary artery stenosis were com-pared between the two groups.Results The total effective rate of PCI in the study group was 93.33%,which was sig-nificantly higher than 76.67%in the control group(P<0.05);the values of MCE perfusion parameters A,β,and A×βin the study group were(3.32±1.27)dB,(2.42±0.98)m/s,and(4.52±1.08)db/s,which were significantly higher than(1.75±0.45)dB,(1.83±0.29)m/s,and(2.31±0.42)db/s in the control group(P<0.05).The number of myocardial segments in patients with coronary artery stenosis of 0-49%and those of 50-69%in the study group was 137 and 99,respectively,which was significantly higher than 87 and 71 in the control group(P<00.05),while there was no significant difference in the number of myocardial segments in patients with coronary artery stenosis of 70%-89%between the two groups(P>0.05).When the degree of coronary stenosis was≥90%,the number of myocardial segments in the study group was 29,which was significantly lower than 77 in the control group(P<0.05).Conclusion Application of PCI 2 hours after the onset of AMI can significantly improve the microcirculation perfusion of patients and results in good curative effect,which is worthy of promotion and application.