增强型体外反搏对急性ST段抬高型心肌梗死患者急诊PCI术后冠脉血流的影响

The impact of enhanced external counterpulsation on coronary blood flow in patients with acute ST-segment elevation myocardial infarction after emergency PCI

目的分析增强型体外反搏(EECP)辅助治疗对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉(冠脉)介入治疗(PCI)术后冠状动脉血流的影响。方法以74例急性STEMI患者为研究对象,随机分为研究组(37例)与对照组(37例)。两组均行急诊PCI,研究组术后给予EECP辅助治疗,对照组术后给予气囊包裹但不进行EECP治疗。比较两组不同时点[PCI术后即刻(t1)、EECP/气囊包裹30 min时(t2)、EECP/气囊包裹停止后5 min(t3)]的主动脉血压[收缩压(SBP)、舒张压(DBP)],不同时间点(t1、t3)校正的TIMI帧数(cTFC),手术前后血清心肌损伤标志物[N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)]水平,不良事件与主要不良心脑血管事件(MACCEs)发生情况。结果研究组与对照组t1和t3时主动脉SBP与DBP比较无统计学差异(P>0.05);t2时,研究组SBP(112.8±8.5)mm Hg(1 mm Hg=0.133 kPa)显著低于对照组的(121.3±12.9)mm Hg,DBP(81.3±9.0)mm Hg显著高于对照组的(75.2±10.7)mm Hg(P<0.05)。研究组与对照组t1时cTFC分别为(34.6±14.3)帧与(33.2±12.9)帧,比较无统计学差异(P>0.05);研究组t3时cTFC(25.3±12.2)帧低对照组的(32.7±14.0)帧(P<0.05)。两组术前血清NT-proBNP、CK-MB与cTnI水平比较无统计学差异(P>0.05);两组术后2 h血清NT-proBNP水平均降低,且研究组低于对照组(P<0.05);两组术后2 h血清CK-MB与cTnI水平比较均无统计学差异(P>0.05)。两组不良事件发生率及MACCEs发生率比较无统计学差异(P>0.05)。结论EECP可减少急性STEMI患者急诊PCI术后慢血流与心肌损伤,安全性好。

Objective To analyze the impact of enhanced external counterpulsation(EECP)on coronary blood flow in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods 74 patients with acute STEMI were studied and randomly divided into a study group(n=37)and a control group(n=37).Both groups underwent emergency PCI.The study group received postoperative EECP adjuvant treatment,while the control group received postoperative balloon wrapping but no EECP treatment.The following parameters between two groups were compared:aortic blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)]at different time points[immediately after PCI(t1),30 min after EECP/balloon wrapping(t2),and 5 min after cessation of EECP/balloon wrapping(t3)],corrected TIMI frame count(cTFC)at different time points[t1,t3],serum myocardial markers[N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)]before and after surgery,adverse reactions and major adverse cardiac and cerebrovascular events(MACCEs).Results There was no significant difference in aortic SBP and DBP between the study group and the control group at t1 and t3(P>0.05).At t2,the study group had significantly lower SBP of(112.8±8.5)mm Hg(1 mm Hg=0.133 kPa)than(121.3±12.9)mm Hg of the control group,and significantly higher DBP of(81.3±9.0)mm Hg than(75.2±10.7)mm Hg of the control group(P<0.05).At t1,the cTFC of the study group and the control group were(34.6±14.3)and(33.2±12.9)frames,and there was no statistical difference(P>0.05).At t3,the study group had lower cTFC of(25.3±12.2)frames than(32.7±14.0)frames of the control group(P<0.05).There were no significant differences in serum NT-proBNP,CK-MB and cTnI levels between the two groups before surgery(P>0.05).Serum NT-proBNP levels were reduced in both groups at 2 h after surgery,and the study group was lower than the control group(P<0.05).There was no statistically significant difference in serum CK-MB and cTnI levels between the two groups at 2 h after surgery(P>0.05).There was no statistically significant difference in the incidence of adverse events and MACCEs between the two groups(P>0.05).Conclusion EECP can reduce slow flow and myocardial injury in patients with acute STEMI after emergency PCI,and has good safety.