摘要
目的:通过与微导管冠状动脉给药比较,探讨新型穿孔球囊技术介导冠状动脉内给药对ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗术中无复流的影响及短期预后意义。方法:回顾性收集2020年7月至2021年7月徐州医科大学附属医院709例STEMI患者的手术资料,其中发生术中无复流且给药后恢复血流、成功手术者81例,按照给药方式分为经微导管给药组(n=46)和穿孔球囊给药组(n=35)。通过CVI42绘制获得所有患者微循环梗阻占心肌质量的百分比(MVO%)。比较两组患者恢复TIMI血流3级的时间、给药次数、术中不良反应发生率及MVO%。随访患者6个月主要不良心血管事件(心原性死亡、再发心肌梗死、非计划血运重建、心力衰竭再入院)的发生情况,探究两种不同给药方式对术中无复流患者的短期预后意义。结果:所有患者平均年龄为(57.5±13.2)岁,男性占86.4%。经微导管给药组和穿孔球囊给药组的基线资料差异无统计学意义(P均>0.05)。两组间给药剂量、给药次数及低血压发生率差异均无统计学意义(P均>0.05);但与经微导管给药组相比,穿孔球囊给药组恢复TIMI血流3级的时间较短,除支架外的手术费用较低(P均<0.01),微循环梗阻的发生比例和MVO%均降低(P均<0.05)。随访6个月时,经微导管给药组和穿孔球囊给药组的主要不良心血管事件发生率分别为19.6%和11.4%,差异无统计学意义(P>0.05),两组间心原性死亡率、再发心肌梗死发生率、非计划血运重建率、心力衰竭再入院率差异均无统计学意义(P均>0.05)。结论:新型穿孔球囊技术冠状动脉内给药可以用于STEMI术中无复流,而且是一种简单方便、经济有效的方法,其6个月随访结果不劣于经微导管冠状动脉内给药方法。
Objectives:To investigate the effect of intracoronary sodium nitroprusside administration by a new perforated balloon technique on no-reflow during primary percutaneous coronary intervention(PPCI)in patients with acute ST segment elevation myocardial infarction(STEMI)and its influence on the short-term prognosis.Methods:The procedural data of 709 STEMI patients hospitalized in the Affiliated Hospital of Xuzhou Medical University from July 2020 to July 2021 were retrospectively collected.Among them,81 patients who had no-reflow during PPCI and recovered blood flow after sodium nitroprusside administration were included in the final analysis.Patients were divided into microcatheter group(n=46)and perforated balloon group(n=35).The percentage of microcirculation obstruction in myocardial mass(MVO%)was obtained by CVI42 mapping.The time to restoring TIMI blood flow level 3,the times of administration,the incidence of peri-procedural adverse reactions and MVO%were compared between the two groups.The main adverse cardiovascular events(cardiogenic death,recurrent myocardial infarction,unplanned revascularization,and readmission for heart failure)of the patients were followed up for 6 months.Results:The mean age was(57.5±13.2)years,and 86.4%were male.No significant difference was found in the baseline characteristics between the two groups.There was no significant difference in dosage,times of administration and incidence of hypotension between the two groups(all P>0.05),but compared with the microcatheter group,the perforated balloon group experienced shorter time to restoring TIMI flow level 3 and lower procedural expenses excluding stents(all P<0.01).The incidence of microcirculation obstruction and MVO%were significantly lower in the perforated balloon group than in the microcatheter group(all P<0.05).At 6-month follow up,the rate of major adverse cardiovascular events was similar between the two groups(microcatheter group[19.6%]vs.perforated balloon group[11.4%],P>0.05),and there was no significant difference in cardiogenic death,recurrent myocardial infarction,unplanned revascularization,and readmission for heart failure between the two groups(all P>0.05).Conclusions:The new perforated balloon technique for intracoronary administration of sodium nitroprusside can be safely used in STEMI patients with no reflow during PPCI,and it is a simple,convenient,economical and effective method.As for the 6-month follow-up results,it is not inferior to the method of intracoronary administration via microcatheter in these patients.
作者
苗浩
段洋
裴思雨
陆远
徐晤
李承宗
MIAO Hao;DUAN Yang;PEI Siyu;LU Yuan;XU Wu;LI Chengzong(Department of Cardiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou(221000),Jiangsu,China)
出处
《中国循环杂志》
CSCD
北大核心
2023年第1期41-48,共8页
Chinese Circulation Journal
基金
江苏省徐州市科技发展项目重点研发计划(社会发展)资助项目(KC20105)。
关键词
ST段抬高型心肌梗死
急诊经皮冠状动脉介入治疗
无复流
穿孔球囊技术
微循环梗阻
心脏磁共振成像
ST segment elevation myocardial infarction
primary percutaneous coronary intervention
no-reflow
perforated balloon technique
microcirculation obstruction
cardiac magnetic resonance imaging
