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目的研究不同的院前脉压数值对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入术(PCI)治疗后主要心血管不良事件(MACE)发生率及血清内肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTn-I)及血浆氨基末端脑钠尿肽前体(NT-proBNP)水平的影响。方法以2014年1月至2016年10月期间于上海市第十人民医院行PCI治疗的急性STEMI患者为研究对象,根据脉压分为:H组:脉压>60 mmHg;M组:脉压20~60 mmHg;L组:脉压<20 mmHg。观察3组患者冠脉病变程度,检测PCI术前及术后TIMI血流情况,同时记录血清CK-MB、cTn-I、NT-proBNP峰值,对比PCI术后MACE的发生率。结果冠脉病变血管数及部位由轻到重依次为M组、H组、L组,组间两两比较差异有统计学意义(P<0.05);PCI术前,罪犯血管血流情况为M组优于H组,L组次于H组,3组间差异有统计学意义(P<0.05),PCI术后3组间差异无统计学意义(P>0.05);PCI围术期,CK-MB、cTn-I、NT-proBNP峰值水平均表现为:L组>H组>M组,组间两两比较差异有统计学意义(P<0.05);PCI术后,3组患者的MACE发生率为L组>H组>M组,且L组显著高于M组,差异有统计学意义(P<0.05)。结论脉压水平越低,急性STEMI患者于PCI术后的MACE发生率以及血清CK-MB、cTn-I、NT-proBNP水平越高,提示脉压对急性STEMI患者PCI术后的MACE发生率有一定的预测作用。
Objective To study the effect of different prehospital pulse pressure values on the incidence of major adverse cardiac events (MACE) and serum creatine kinase in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) (CK-MB), cardiac troponin I (cTn-I), and plasma NT-proBNP levels were measured. Methods Acute STEMI patients undergoing PCI in Shanghai Tenth People’s Hospital from January 2014 to October 2016 were divided into two groups according to pulse pressure: group H: pulse pressure> 60 mmHg; group M: pulse pressure 20 ~ 60 mmHg; L group: pulse pressure <20 mmHg. The degree of coronary artery lesion was observed in 3 groups. The TIMI blood flow before and after PCI was measured. The peak values of serum CK-MB, cTn-I and NT-proBNP were recorded, and the incidence of MACE after PCI was compared. Results The number of vessels and the location of coronary lesions were M, H and L with statistical significance (P <0.05). Before PCI, the vascular blood flow of criminals was M (P <0.05). There was no significant difference between the three groups after PCI (P> 0.05). In the perioperative period of PCI, the level of CK The peak levels of -MB, cTn-I and NT-proBNP were all as follows: L group> H group> M group, there was significant difference between groups (P <0.05); After PCI, the MACE The incidence of L group> H group> M group, and L group was significantly higher than M group, the difference was statistically significant (P <0.05). Conclusions The lower the pulse pressure, the higher the incidence of MACE and the levels of CK-MB, cTn-I and NT-proBNP in patients with acute STEMI after PCI, suggesting that there is MACE in patients with acute STEMI after PCI Certain predictive effect.