摘要
目的探讨1期支架置入和延期支架置入对高血栓负荷急性ST段抬高性心肌梗死(STEMI)患者QTc离散度、心肌灌注的影响。方法选取2019年9月至2021年2月保定市第二医院收治的80例高血栓负荷STEMI患者,根据随机数字表法分为1期组和延期组,各40例。两组均行经皮冠状动脉介入术(PCI),1期组术中采用1期支架置入,延期组术中采用延期支架置入。统计两组支架置入后2 h ST段回落指数、QTc离散度(QTcd)、校正QT间期(QTc)、冠状动脉血流情况、心肌灌注、血栓积分、血小板计数(PLT)、D-二聚体(D-D)、微小RNA-302b(miR-302b)、B型钠尿肽(BNP)、PCI情况,并随访主要心血管不良事件(MACE)。结果支架置入后2 h延期组QTcd(40.33±3.39)ms、QTc(42.30±5.51)ms低于1期组(55.15±4.06)ms、(58.82±5.17)ms,差值(27.68±5.15)、(28.03±4.89)高于1期组(11.84±4.48)、(12.63±3.95)(P<0.05),支架置入后2 h ST段回落指数高于1期组(P<0.05);支架置入后2 h延期组冠状动脉血流情况优于1期组(P<0.05);支架置入后2 h延期组血栓积分(2.41±0.16)分低于1期组(2.58±0.23)分,心肌灌注积分(2.65±0.11)分高于1期组(2.50±0.12)分,差值(0.81±0.04)分、(1.63±0.15)分大于1期组(0.58±0.05)分、(1.47±0.10)分(P<0.05);支架置入后2 h两组miR-302b、BNP水平低于支架置入前(P<0.05),支架置入后2 h延期组PLT(125.56±15.51)×10^(9)/L、D-D(0.40±0.08)mg/L水平低于1期组(182.33±17.65)×10^(9)/L、D-D(0.52±0.10)mg/L(P<0.05);延期组无复流/慢血流发生率17.50%低于1期组(40.00%,P<0.05);术后1个月随访,两组均无脱落病例。两组MACE发生率比较,差异无统计学意义(P>0.05)。结论延期支架置入有助于降低高血栓负荷STEMI患者QTcd,改善心肌灌注,抑制血栓形成,减少无复流/慢血流发生率。
Objective To investigate the effects of stage 1 stent placement and delayed stent placement on the QTc dispersion and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI)with high thrombotic load.Methods A total of 80 patients with STEMI with high thrombus burden who were admitted to Baoding Second Hospital from September 2019 to February 2021 were selected and divided into the stage 1 group and extension group according to the random number table method,with 40 cases in each.Both groups underwent percutaneous coronary intervention(PCI).The first-stage stenting was used in the first-stage group,and the delayed stenting was used in the delayed group.The ST segment fall index,QTc dispersion(QTcd),corrected QT interval(QTc),coronary blood flow,myocardial perfusion,thrombus integral,platelet count(PLT),D-2 Polymer(DD),microRNA-302b(miR-302b),B-type natriuretic peptide(BNP),PCI,and follow-up for major adverse cardiovascular events(MACE)were recorded.Results The QTcd(40.33±3.39)ms and QTc(42.30±5.51)ms of the extension group 2 hours after stent placement were lower than those of the stage 1 group(55.15±4.06)ms and(58.82±5.17)ms,the difference was(27.68±5.15)and(28.03±4.89)which were higher than those in the stage 1 group(11.84±4.48)and(12.63±3.95)(P<0.05);and the ST segment regression index 2 h after stent placement was higher than that in the stage 1 group(P<0.05).The coronary blood flow in the 2-hour extension group after stenting was better than that in the stage 1 group(P<0.05);the thrombus score in the 2-hour extension group after stenting(2.41±0.16)was lower than that in the stage 1 group(2.58±0.23).The myocardial perfusion score of the extension group(2.65±0.11)was higher than that of the stage 1 group(2.50±0.12),and the difference was(0.81±0.04),(1.63±0.15)higher than that of the stage 1 group(0.58±0.05),(1.47±0.10)points(P<0.05);mi R-302b and BNP mg/L water in group 2 were lower than those before stent placement and mg/L 2 h after stent placement(P<0.05)
作者
陈雪
郑晓
杨枫
CHEN Xue;ZHENG Xiao;YANG Feng(Department of Cardiovascular Medicine,Baoding Second Hospital,Baoding 071000,China)
出处
《中国心血管病研究》
CAS
2022年第5期444-449,共6页
Chinese Journal of Cardiovascular Research
基金
保定市科技计划项目(2141ZF013)。
关键词
高血栓负荷
急性ST段抬高性急性心肌梗死
延期支架置入
1期支架置入
QTC离散度
心肌灌注
Hyperthrombotic load
Acute ST-segment elevation acute myocardial infarction
Delayed stent placement
Stage 1 stent placement
QTc dispersion
Myocardial perfusion
