急性心肌梗死患者经皮冠状动脉介入治疗后心肺运动功能特点分析

Characteristics of cardiopulmonary exercise testing in patients with acute myocardial infarction after percutaneous coronary intervention

目的分析不同类型急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后心肺运动试验(CPET)的临床特点。方法选取自2015年11月至2021年9月于北部战区总医院接受PCI治疗且行CPET检查的653例AMI患者为研究对象。根据心电图是否含有ST段抬高将患者分为急性非ST段抬高型心肌梗死(NSTEMI)组(n=362)与急性ST段抬高型心肌梗死(STEMI)组(n=291)。比较两组患者的基线资料与CPET检测结果。结果两组患者吸烟史、饮酒史、高血压、糖尿病、卒中史比例及体质量指数、心率、舒张压、血红蛋白、甘油三酯、低密度脂蛋白、总胆固醇比较,差异均无统计学意义(P>0.05);STEMI组患者男性、陈旧性心肌梗死、PCI史比例及年龄、N-末端脑钠肽前体、收缩压均高于NSTEMI组,左室射血分数、高密度脂蛋白均低于NSTEMI组,差异均有统计学意义(P<0.05)。STEMI组患者峰值心率、峰值功率、峰值代谢当量、峰值摄氧量、峰值氧脉搏、运动时长均低于NSTEMI组,差异均有统计学意义(P<0.05)。结论不同类型AMI患者的CPET指标存在一定差异,STEMI患者具有较差的运动耐力。

Objective To analyze the clinical characteristics of cardiopulmonary exercise testing(CPET)after percutaneous coronary intervention(PCI)in patients with different types of acute myocardial infarction(AMI).Methods From November 2015 to September 2021,653 patients with AMI who underwent PCI and CPET in General Hospital of Northern Theater Command were selected as the study objects.Patients were divided into non-ST elevated myocardial infarction(NSTEMI)group(n=362)and ST elevation myocardial infarction(STEMI)group(n=291)according to the presence or absence of ST elevation in the electrocardiogram.Baseline data and CPET test results were compared between the two groups.Results There were no significant differences in smoking history,drinking history,hypertension,diabetes,stroke history,body mass index,heart rate,diastolic blood pressure,hemoglobin,triglyceride,low density lipoprotein and total cholesterol between 2 groups(P>0.05).Male,old myocardial infarction,PCI history ratio and age,N-terminal brain natriuretic peptide precursor and systolic blood pressure in STEMI group were higher than those in NSTEMI group,while left ventricular ejection fraction and high density lipoprotein in STEMI group were lower,with statistical significance(P<0.05).The peak heart rate,peak power,peak metabolic equivalent,peak oxygen uptake,peak oxygen pulse and exercise duration in STEMI group were lower than those in NSTEMI group,and the differences were statistically significant(P<0.05).Conclusion There are some differences in CPET indexes in patients with different types of AMI,STEMI patients have poor exercise endurance.