急诊介入手术治疗老年急性心肌梗死的近期疗效及其对患者血清炎症因子的影响

Effect of emergency percutaneous coronary intervention on the short-term efficacy, complications and serum inflammatory factors in elderly patients with acute myocardial infarction

目的探讨急诊介入手术治疗老年急性心肌梗死的近期疗效及其对患者血清炎症因子的影响。方法选择我院2014年1月至2015年5月收治的80例老年急性心肌梗死(AMI)患者,按随机数字表法均分为两组各40例,观察组患者使用急诊介入手术(PCI)治疗,对照组患者使用保守药物治疗,比较两组患者的治疗效果、心功能指标左射血分数(LVEF)、左心室舒张末期内径(LVED)、二尖瓣E峰/A峰值,以及血清炎症因子的变化和并发症发生情况。结果观察组患者治疗1周后的心功能指标LVEF、LVED及二尖瓣E峰/峰值分别为(53.0±4.5)%、(47.9±3.7)mm、(1.17±0.44),改善程度明显优于对照组(48.3±5.3)%、(50.8±3.4)mm、(0.78±0.38),差异均具有统计学意义(P<0.05);治疗后观察组患者的血清炎症因子hs-CRP水平为(5.3±3.2)mg/L,明显低于对照组(8.4±3.6)mg/L,其治疗48 h后ST段回落37例(92.5%),低于对照组的30例(75.0%),且死亡率为0,低于对照组的7.5%,差异均具有统计学意义(P<0.05)。观察组患者治疗后的心力衰竭、猝死及复发性心肌梗死等并发症发生率为7.5%(3/40),明显低于对照组的30.0%(12/40),差异具有统计学意义(P<0.05)。结论老年AMI患者使用急诊介入治疗近期疗效显著,且能降低死亡率及并发症发生率,值得临床推广应用。

Objective To investigate the short-term effect of emergency percutaneous coronary intervention in the treatment of elderly patients with acute myocardial infarction(AMI), and its influence on complications and serum inflammatory factors. Methods Eighty cases of elderly patients with AMI in our hospital from January 2014 to May2015 were selected and divided into two groups according to the random number table methods, with 40 cases in each group. Patients in the observation group received emergency surgical intervention(PCI) treatment, while the control group was treated with conservative medical treatment. The therapeutic effect, heart function index of left ejection fraction(LVEF), left ventricular diastolic end diastolic diameter(LVED) and mitral E/A peak, inflammatory factor as well as the complications of the two groups of patients were compared. Results The improvement of cardiac function indexes LVEF, LVED and mitral E peak/A peak after 1 week of treatment in the observation group were respectively(53.0±4.5)%,(47.9±3.7) mm,(1.17±0.44), significantly better than(48.3±5.3)%,(50.8±3.4) mm,(0.78±0.38) in the control group, and the difference was statistically significant(P<0.05). After treatment, the level of serum inflammatory factor hs-CRP in the observation group was(5.3±3.2) mg/L, significantly lower than(8.4±3.6) mg/L in the control group. The treatment of ST after 48 h was 37 cases(92.5%), higher than 30 cases(75.0%) in the control group, and the mortality rate was 0, lower than 7.5% of the control group. The differences were statistically significant(P<0.05). The incidence of heart failure, sudden death and recurrent myocardial infarction after treatment in the observation group was7.5%(3/40), which was significantly lower than that in the control group [30.0%(12/40)], and the difference was statistically significant(P<0.05). Conclusion The use of emergency interventional therapy for elderly patients with AMI has significant short-term curative effect, which can reduce the incidence of mortality and complications that is worthy of clinical application.