摘要
目的观察早期应用普通肝素在行急诊直接经皮冠状动脉介入术(pPCI)治疗的急性ST段抬高型心肌梗死(ASTEMI)患者中的应用效果。方法将行急诊pPCI治疗的161例ASTEMI患者随机分为早期组78例与常规组83例。早期组患者在确诊ASTEMI后立即给予普通肝素治疗,常规组患者则在动脉穿刺成功后给予等量普通肝素治疗。比较两组患者的临床相关指标(术后ST段回落率、术后肌钙蛋白T峰值)、pPCI相关指标[pPCI术后即刻的心肌梗死溶栓治疗(TIMI)血流分级3级比例、TIMI心肌灌注分级(TMPG)3级比例]、术后30 d主要心血管不良事件(MACE)的发生率,以及出院前、术后12周的心脏彩超指标[左心室舒张末期内径、左心室射血分数、左心室舒张早期与舒张晚期二尖瓣血流速度比值(E/A)、左心室整体纵向应变(GLS)]。结果两组患者术后即刻TIMI血流分级3级和TMPG 3级比例,以及肌钙蛋白T峰值、院内出血的发生率、术后30 d MACE的发生率比较,差异均无统计学意义(均P>0.05),而早期组术后心电图ST段回落率高于常规组(P<0.05)。出院前两组心脏彩超指标差异无统计学意义;而术后12周,早期组E/A和左心室GLS均高于常规组(均P<0.05)。结论发病早期给予普通肝素治疗可以更好地提高行急诊pPCI治疗的ASTEMI患者的心电图ST段回落率,改善心肌灌注及心室功能。
Objective To observe the application effect of early administration of unfractionated heparin on patients with acute ST-segment elevation myocardial infarction(ASTEMI)undergoing emergency primary percutaneous coronary intervention(pPCI).Methods A total of 161 patients with ASTEMI treated with emergency pPCI were randomly divided into early group(n=78)and routine group(n=83).Patients in the early group were given unfractionated heparin therapy immediately after the definite diagnosis of ASTEMI,while patients in the routine group were treated with the same amount of unfractionated heparin after successful arterial puncture.The two groups were compared in terms of related clinical indices(postoperative ST-segment fall rate,peak value of postoperative cardiac troponin T),pPCI-related indices(proportion of thrombolysis in myocardial infarction[TIMI]blood flow grade 3,and proportion of TIMI myocardial perfusion grade[TMPG]3 immediately after pPCI),incidence rate of major adverse cardiovascular events(MACE)30 days after operation,and Doppler echocardiographic indices before discharge and 12 weeks after operation(left ventricular end-diastolic dimension,left ventricular ejection fraction,ratio of left ventricular early diastolic mitral velocity to late diastolic mitral velocity[E/A],and left ventricular longitudinal strain[GLS]).Results There was no statistically significant difference in the proportion of TIMI blood flow grade 3 or TMPG grade 3 immediately after operation,peak value of troponin T,incidence rate of in-hospital hemorrhage,or incidence rate of postoperative 30-day MACE between the two groups(all P>0.05),but the early group yielded a higher rate of postoperative ST-segment fall on ECG than the routine group(P<0.05).Echocardiographic indices showed no statistically significant difference between the two groups before discharge;twelve weeks after operation,the early group had higher E/A and left ventricular GLS than the routine group(all P<0.05).Conclusion The administration of unfractionated heparin at early
作者
于淼
金忠志刚
黄龙澳
张薇
姜薇
李潞
YU Miao;JIN Zhong-zhigang;HUANG Long-ao;ZHANG Wei;JIANG Wei;LI Lu(Department of Cardiology,the Second Affiliated Hospital of Shenyang Medical College,Shenyang 110002,China;Department of Ultrasound,the Second Affiliated Hospital of Shenyang Medical College,Shenyang 110002,China)
出处
《广西医学》
CAS
2021年第9期1045-1049,共5页
Guangxi Medical Journal
基金
辽宁省科技计划(2018225015)
辽宁省沈阳市科学技术计划(19-110-4-28)。
关键词
急性ST段抬高型心肌梗死
普通肝素
早期用药
急诊直接经皮冠状动脉介入术
心室功能
心肌灌注
Acute ST-segment elevation myocardial infarction
Unfractionated heparin
Early-stage medication
Emergency primary percutaneous coronary intervention
Ventricular function
Myocardial perfusion
