摘要
目的 探讨血运重建时机对急性心肌梗死(AMI)患者血管再通率、心肌微循环、心功能及预后的影响。方法 选取2019年1月—2021年6月收治的556例AMI,根据血运重建时机分为早期组和晚期组各278例。早期组入院12~<24 h行血运重建,晚期组入院24~<72 h行血运重建。比较2组血管再通率和治疗前、治疗后7 d、治疗后3个月心肌微循环指标[造影剂开始灌注时间(AT)、灌注达峰时间(APT)、灌注峰值强度(PI)、曲线上升斜率(β)、心肌血流量(MBF)]、心肌损伤指标[血清肌钙蛋白I(cTnI)、心肌型肌酸激酶同工酶(CK-MB)、N末端脑钠肽前体(NT-proBNP)]、血管内皮功能指标[血清内皮细胞特异性分子-1(ESM-1)、内皮素-1(ET-1)、一氧化氮(NO)]水平,以及治疗前、治疗后3个月心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)],并统计2组治疗后6个月预后情况。结果 早期组血管再通率(96.40%,268/278)高于晚期组(90.29%,251/278)(P<0.01)。治疗后7 d、治疗后3个月早期组AT、APT、PI、β、cTnI、CK-MB、NT-proBNP、ESM-1、ET-1低于晚期组,MBF、NO高于晚期组(P<0.01);治疗后3个月早期组LVEF高于晚期组,LVDs、LVDd、LVESV、LVEDV低于晚期组(P<0.01)。早期组治疗后6个月主要心血管不良事件(MACE)发生率低于晚期组(P<0.05)。结论 入院12~<24 h行血运重建能显著提高AMI患者血管再通率,改善心肌微循环,促进心肌损伤修复,纠正血管内皮功能紊乱,加快心功能恢复,且MACE发生风险较低。
Objective To investigate the effects of revascularization timing on vascular revascularization rate,myocardial microcirculation,cardiac function and prognosis in patients with acute myocardial infarction(AMI).Methods A total of 556 patients with AMI treated from January 2019 to June 2021 were selected and divided into early stage group(n=278)and late stage group(n=278)according to the timing of revascularization.The early stage group underwent revascularization within 12 to 24 h after admission,and the late stage group underwent revascularization within 24 to 72 h after admission.The rate of vascular revascularization,myocardial microcirculation indicators[starting time of contrast agent perfusion(AT),time to peak perfusion(APT),peak perfusion intensity(PI),curve rise slope(β),myocardial blood flow(MBF)],myocardial injury indicators[cardiac troponin I(cTnI),myocardial creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)],vascular endothelial function indicators[serum endothelial cell specific molecule-1(ESM-1),endothelin-1(ET-1),nitric oxide(NO)]before treatment,at 7 d and 3 months after treatment was compared between the two groups,and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVDs),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume(LVEDV)]were also analyzed before treatment and at 3 months after treatment.Results The rate of vascular revascularization in early stage group(96.40%,268/278)was higher than that in late stage group(90.29%,251/278),with significant difference(P<0.01).AT,APT,PI,β,cTnI,CK-MB,NT-proBNP,ESM-1 and ET-1 in early stage group were lower than those in late stage group at 7 d and 3 months after treatment,while MBF and NO were higher than those in late stage group(P<0.01).At 3 months after treatment,LVEF in early stage group was higher than that in late stage group,while LVDs,LVDd,LVESV and LVEDV were lower than those in late stage group(P<0.01).The incidence of major adverse cardiovascular events(MACE)at 6 months after treatment in the early stage group was lower than that in the late stage group(P<0.05).Conclusion Revascularization within 12 to 24 h after admission can significantly increase the rate of vascular revascularization in AMI patients,improve myocardial microcirculation,promote myocardial damage repair,correct vascular endothelial dysfunction,accelerate cardiac function recovery,and lower the risk of major adverse cardiovascular events.
作者
孙亚丽
刘心雨
张雪莲
宋欣仪
任淑红
张美玲
SUN Yali;LIU Xinyu;ZHANG Xuelian;SONG Xinyi;REN Shuhong;ZHANG Meiling(Department of Cardiology,Central Hospital of Songjiang District,Shanghai 201600,China;Department of Medical Imaging,the Sixth People's Hospital of Zhengzhou City,Zhengzhou 450000,China)
出处
《临床误诊误治》
CAS
2023年第8期40-45,共6页
Clinical Misdiagnosis & Mistherapy
基金
上海市卫生健康委科研项目(2021SH101)。
关键词
心肌梗死
血运重建
血管再通率
灌注达峰时间
心肌血流量
肌钙蛋白Ⅰ
内皮素-1
预后
Myocardial infarction
Revascularization
Vascular revascularization rat
Peak perfusion time
Myocardial blood flow
Troponin I
Endothelin-1
Prognosis
