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目的探讨静脉溶栓后行早期经皮冠状动脉介入术(PCI)对ST段抬高型心肌梗死(STEMI)患者心肌灌注的影响。方法选取2014年1月—2016年6月湖北医药学院附属随州医院收治的STEMI患者150例,根据治疗方案分为对照组和观察组,每组75例。对照组患者行急诊PCI,观察组患者经静脉溶栓后行早期PCI;两组患者术后均随访6个月。比较两组患者PCI前后心肌灌注情况及PCI后7 d、6个月心功能指标。结果观察组患者PCI前后TIMI心肌灌注分级(TMPG)为2~3级者比例均高于对照组(P<0.05);对照组患者PCI后TMPG为2~3级者比例高于PCI前(P<0.05);观察组患者PCI后TMPG分级为2~3级者比例与PCI前比较,差异无统计学意义(P>0.05)。两组患者PCI后7 d左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)比较,差异无统计学意义(P>0.05);观察组患者PCI后6个月LVEDD、LVEDV低于对照组,LVEF高于对照组(P<0.05);两组患者PCI后6个月LVEDD、LVEDV低于PCI后7 d,LVEF高于PCI后7 d(P<0.05)。结论静脉溶栓后行早期PCI可有效改善STEMI患者心肌灌注和心功能。
Objective To investigate the effect of early percutaneous coronary intervention (PCI) on myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) after intravenous thrombolysis. Methods A total of 150 STEMI patients admitted to Suizhou Hospital affiliated to Hubei Medical College from January 2014 to June 2016 were selected and divided into control group and observation group with 75 cases in each group. Patients in the control group underwent emergency PCI, and patients in the observation group underwent early PCI after intravenous thrombolysis. Both groups were followed up for 6 months. The myocardial perfusion before and after PCI and the cardiac function at 7 and 6 months after PCI were compared between the two groups. Results The ratio of TIMI myocardial perfusion grading (TMPG) grade 2 ~ 3 before and after PCI in observation group was higher than that in control group (P <0.05). In control group, the ratio of TMPG grade 2 ~ 3 after PCI was higher than that before PCI <0.05). There was no significant difference in the proportion of TMPG grade 2 to 3 after PCI in observation group patients (P> 0.05). There was no significant difference in LVEDD, LVEDV and LVEF between the two groups on the 7th day after PCI (P> 0.05). In the observation group, the PCI The LVEDD and LVEDV were lower in the 6 months after PCI than those in the control group (P <0.05). LVEDD and LVEDV at 6 months after PCI were lower than those at 7 days after PCI <0.05). Conclusion Early PCI after intravenous thrombolysis can effectively improve myocardial perfusion and cardiac function in patients with STEMI.