摘要
目的:探讨急性ST段抬高心肌梗死(心梗)(STEMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注不良的影响因素。方法:根据PCI后心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMPG),91例患者分为心肌灌注不良组(TMPG0～2级,n=30)和心肌灌注正常组(TMPG3级,n=61),比较2组基本临床资料和造影结果以及介入结果,并对各因素进行Logistio回归分析,总结急性心梗急诊PCI后心肌灌注不良的影响因素。结果:91例患者中男76例,女15例,年龄38～84(62.3±11.8)岁,心肌灌注不良组合并高血压病的比例更高(80.0%比54.1%,P=0.0163),心梗部位以非前壁心梗居多(70.0%比29.5%,P=0.002);造影结果中,心肌灌注不良组梗死相关血管以右冠状动脉(RCA)更多见(63.3%比18.0%,P<0.0001),术前校正的TIMI血流帧数计数(CTFC)值[(97.7±12.6)帧比(87.3±26.4)帧,P=0.0414]和术前心肌呈色分级(MBG)0级的比例(93.3%比75.4%,P=0.0268)也是心肌灌注不良组更高;单因素回归分析显示高血压、非前壁心梗、发病至球囊开通时间、犯罪血管为RCA、术前MBG均是PCI后心肌灌注不良的预测因素,但多因素Logistio回归分析发现,仅发病至球囊开通时间是PCI后心肌灌注不良的独立危险因素。结论:高血压、非前壁心梗、犯罪血管为RCA、术前CTFC及术前MBG、发病至球囊开通时间均是PCI后TMPG的影响因素,其中发病至球囊开通时间是PCI后TMPG低的独立危险因素,发病至球囊开通时间越长,PCI后TMPG越低,心肌灌注越差。
Objective To study the factors of inducing low myocardial perfusion after percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction （STEMI）. Methods Ninety one acute STEMI patients were divided into two groups by thrombolysis in myocardial infarction myocardial perfusion grade （TMPG） after percutaneous coronary intervention （PCI）. One group had low myocardial perfusion （TMPG 0-2, n=30）, the other had normal myocardial perfusion （TMPG 3, n=61）. The basic clinical characteristics, angiographie findings and intervention results between these two groups were compared, and logistic regression analysis was performed to analyze the factors of inducing low myocardial perfusion after PCI. Results Of the 91 patients,76 were male and 15 were female, aged from 38 to 84 years. Hypertension （80.0% vs 54.1%,P=0.016 3） and non-anterior wall infarction（70.0% vs 29.5%,P=0.002） were more frequently observed in low myocardial perfusion group. Right coronary artery （RCA） was the more frequently observed infarction-related artery in low myocardial perfusion group than that in normal myocardial perfusion group （63.3% vs 18.0%,P〈0.000 1）. Corrected frame count （CTFC）（97.7±12.6 vs 87.3±26.4,P=0.041 4） and percentage with myocardial blush grade （MBG） 0 （93.3% vs 75.4% ,P=0.026 8） before PCI were higher in low myocardial perfusion group than that in normal myocardial perfusion group. Univariate logistic regression analysis showed that hypertension, non-anterior wall infarction, onset of infarction to balloon opening time, RCA as culprit vessel and MBG before PCI were factors correlated with low myocardial perfusion after PCI. Multivariate logistic regression analysis showed that onset of infarction to balloon opening time was the sole independent predicting factor of low myocardial perfusion after PCI. Conclusions Hypertension, non-anterior wall infarction, RCA as culprit vessel, onset of infarction to balloon opening time, CTFC and MBG before PCI ar
出处
《内科理论与实践》
2009年第3期183-187,共5页
Journal of Internal Medicine Concepts & Practice
基金
上海市优秀学科带头人基金(项目编号:35508XD14026)
上海市科委登高重点课题(项目编号:064119501)
浦东新区重大协作课题(项目编号:PW2006D-3)
关键词
急性ST段抬高心肌梗死
经皮冠状动脉介入治疗
心肌灌注
影响因素
Acute ST-elevation myocardial infarction
Percutaneous coronary intervention
Myocardial perfusion
Influential factor
