摘要
目的:探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者在转运至行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)之前用普通肝素预处理对接受直接PCI的冠脉血流、心功能和出血事件发生率的影响。方法:采用回顾性队列研究方法,连续入选2020年6月1日-2022年6月30日于济宁市第一人民医院行直接PCI的STEMI患者138例,其中13例患者信息不完整,最终125例患者被纳入分析。根据肝素使用时间点,分为转运前抗凝组(确诊后于当地医院给药,共65例)和常规抗凝组(导管室内给药,共60例)。收集患者基线资料、胸痛中心时间节点、心肌损伤标记物等指标。主要观察指标为开通血管即刻的冠脉血流(TIMI血流分级),次要观察指标为患者心功能(左室射血分数、N末端B型钠尿肽前体)、心肌损伤标志物(心肌肌钙蛋白I、肌红蛋白、肌酸激酶、肌酸激酶同工酶)、出血风险及不良心血管事件。结果:两组患者基线资料、救治时间节点、病变血管差异无统计学意义(P>0.05);常规抗凝组心肌损伤标志物肌酸激酶同工酶水平高于转运前抗凝组,差异有统计学意义(P<0.05);常规抗凝组肌红蛋白水平高于转运前抗凝组,差异有统计学意义(P<0.05);转运前抗凝组左室射血分数高于常规抗凝组,差异有统计学意义(P<0.05);转运前抗凝组梗死相关动脉(infarct-related artery,IRA)开通即刻TIMI血流分级0~1级35例(58.3%),常规抗凝组49例(78.3%),差异有统计学意义(P<0.05);进行多因素二元logistic回归分析,以校正混杂因素影响,转运前抗凝是IRA初始血流2~3级发生率的独立预测因素(OR=3.576,95%CI:1.337~9.519,P=0.011)。两组不良事件及出血事件发生率差异无统计学意义(P>0.05)。结论:转运前使用普通肝素预处理可改善STEMI患者IRA通畅性和心功能而不增加不良心血管事件及出血事件的发生率。
Objective To investigate the effect of unfractionated heparin pretreatment on coronary blood flow,cardiac function and in-hospital bleeding events in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods A retrospective cohort study was conducted on continuously selected 125 STEMI patients who underwent direct PCI in Jining First People's Hospital from June 1,2020 to June 30,2022.According to the time point of heparin use,they were divided into pre-transport anticoagulation group(65 cases,who were administered in local hospitals after diagnosis)and conventional anticoagulation group(60 cases,who were administered in catheter room).Baseline data,time node of chest pain center and biochemical indicators were collected.The main observation indexes were the coronary blood flow(TIMI blood flow grade)immediately after opening the blood vessel,and the secondary observation indexes were cardiac function(left ventricular ejection fraction,NT-proBNP),myocardial injury markers(cTnI,myoglobin,CK,creatine kinase isoenzyme[CK-MB]),bleeding risk and adverse cardiovascular events.Results There was no significant difference in baseline data,time node of treatment and diseased blood vessels between the two groups(P>0.05).The level of CK-MB in the conventional anticoagulation group was higher than that in the pre-transport anticoagulation group,and the difference was statistically significant(P<0.05).The myoglobin level of the conventional anticoagulation group was higher than that of the pre-transport anticoagulation group,and the difference was statistically significant(P<0.05).The left ventricular ejection fraction(LVEF)in the pre-transport anticoagulation group was higher than that in the conventional anticoagulation group,and the difference was statistically significant(P<0.05).There were 35 cases(58.3%)of TIMI blood flow grade 0-1 in the pre-transport anticoagulation group and 49 cases(78.3%)in the conventional anticoagulation group(P<0.05).Mult
作者
李亚
宋大庆
孙树印
王健
王杰
吴冬
万冬梅
LI Ya;SONG Daqing;SUN Shuyin;WANG Jian;WANG Jie;WU Dong;WAN Dongmei(Department of Emergency,Jining First People's Hospital,Jining,Shandong,372000,China;Department of Critical Care,Leshan People's Hospital)
出处
《临床急诊杂志》
CAS
2024年第6期282-287,共6页
Journal of Clinical Emergency
基金
济宁市重点研发基金资助项目(No:2021YXNS016、2022YXNS130)。
关键词
急性ST段抬高型心肌梗死
经皮冠状动脉介入治疗
普通肝素
冠脉血流
心功能
acute ST-segment elevation myocardial infarction
percutaneous coronary intervention
heparin
coronary blood flow
cardiac function
