院前静脉溶栓对STEMI患者微循环血流灌注及短期预后的疗效观察
Effect of pre-hospital intravenous thrombolysis on microcirculation perfusion and short-term prognosis in patients with ST-elevation myocardial infarction
安群英 1孟祥会 1潘吉亚 1孙国宁 1张敬1
作者信息
- 1. 053200 河北省衡水市第六人民医院
- 折叠
摘要
目的 院前静脉溶栓对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)术中微循环血流灌注及短期预后的疗效.方法 收集2022年6月至2023年6月收治的STEMI患者,根据再灌注策略,将患者分为院前静脉溶栓后PCI组(58例,A组)和急诊转运PCI组(58例,B组).比较2组介入术中情况、重要部位出血情况及主要不良心脑血管事件(MACCE).结果 A组较B组再灌注时间明显缩短,术前TIMI血流分级≥2级比例增多,置入支架数量下降,术后无复流/慢血流发生率减少;术后7、30、90 d复查心脏超声,A组左心室舒张末内径及WMSI下降,A组30、90 d LVEF升高(P＜0.05);2组患者主要出血事件及MACCE发生率差异无统计学意义(P＞0.05).结论 患者给予院前静脉溶栓能够缩短心肌缺血再灌注时间,减少术中微循环灌注障碍发生率,但主要出血事件和MACCE未增加.
Abstract
Objective To evaluate the therapeutic effect of pre-hospital intravenous thrombolysis on microcirculation perfusion and short-term prognosis in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods STEMI patients admitted from June 2022 to June 2023 were randomly assigned into group A(pre-hospital intravenous thrombolysis,n=58)and group B(PCI after emergency transfer,n=58)according to the reperfusion strategy.Intraoperative conditions,important site bleeding,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the two groups.Results Compared with those of group B,patients in group A presented significantly shorter reperfusion time,more number of patients with preoperative Thrombolysis in Myocardial Infarction(TIMI)of grade 2 and above,less number of stent implants,and lower incidence of non-reperfusion/slow blood flow(P＜0.05).On the 7th,30th,and 90th day after surgery,follow-up echocardiography showed significantly increased left ventricular ejection fraction(LVEF)and decreased left ventricular end-diastolic diameter(LVEDD)and wall motion score index(WMSI)(P＜0.05).There were no significant difference in the incidence of major bleeding events and MACCEs between the two groups(P＞0.05).Conclusion Pre-hospital intravenous thrombolysis effectively shortens the time of myocardial ischemia-reperfusion and reduces the incidence of intraoperative microcirculation perfusion disorders,without increasing the risk of main bleeding events and MACCEs.
关键词
ST段抬高型心肌梗死/院前静脉溶栓/经皮冠状动脉介入术/无复流Key words
ST-segment elevation myocardial infarction/Pre hospital intravenous thrombolysis/percutaneous coronary intervention/non-reperfusion引用本文复制引用
基金项目
衡水市科技计划项目(2023014058Z)
出版年
2024
NETL
NSTL
万方数据