急性ST段抬高型心肌梗死的急诊介入治疗与择期介入治疗预后对比
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Prognosis Comparison Between Emergency Intervention and Elective Intervention in Acute ST Segment Elevation Myocardial Infarction Patients
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    摘要:

    目的观察急诊介入治疗与择期介入治疗对急性ST段抬高型心肌梗死患者的治疗效果及预后。方法回顾性分析524例急性ST段抬高型心肌梗死患者的临床资料。其中471例来诊时在急诊冠状动脉介入治疗时间窗内,行急诊冠状动脉介入治疗(急诊介入治疗组);53例来诊时已超出急诊介入治疗时间窗,常规保守治疗7~10天后择期行冠状动脉介入治疗(择期介入治疗组);两组患者心肌梗死情况及一般资料等具有可比性,比较两组患者术后7天及6个月左心室射血分数、一年随访期间复发梗死再次住院率及30天、一年内死亡情况。结果急诊介入治疗组术后7天(52.3%±7.5%比48.2%±6.9%)及6个月(54.9%±8.2%比50.1%±7.1%)左心室射血分数均明显高于择期介入治疗组(P<0.05);随访1年,急诊介入治疗组住院期间心脏破裂发生率、复发梗死再次住院率、30天死亡率及一年内死亡率(分别为0.42%、6.58%、3.82%和8.28%)显著低于择期介入治疗组(分别为3.77%、16.98%、11.32%和18.87%),差异均有统计学意义(P<0.05)。结论相对择期介入治疗而言,急性ST段抬高型心肌梗死患者采取急诊介入治疗,可迅速改善患者心肌缺血灌注,从而及时减轻患者心肌缺血症状,降低患者再次梗死发生率及死亡率。

    Abstract:

    Aim To observe clinical treatment effect and prognosis of the emergency intervention and elective intervention treatment in acute ST-elevation myocardial infarction(STEMI) patients.Methods Clinical data of 524 patients with STEMI were retrospectively analysed,including 471 patients diagnosed in the emergency percutaneous coronary intervention(PCI) time window,who received emergency treatment,and 53 cases diagnosed beyond the emergency intervention,who received the conventional conservative treatment for 7 to 10 days before PCI.Left ventricular ejection fraction(LVEF) 7 days and six months after PCI,recurrent infarction rehospitalization within a year follow-up period,mortality rate at 30 days and a year,were observed and compared between the two groups.Results LVEF of emergency PCI group 7 days(52.3%±7.5% vs 48.2%±6.9%)and six months(54.9%±8.2% vs 50.1%±7.1%) after PCI were significantly higher than that of elective PCI group(P<0.05);Follow-up 1 year,incidence of cardiac rupture during hospitalization,recurrent infarction rehospitalization rate,mortality rate at 30 days and a year(0.42%,6.58%,3.82% and 8.28%) decreased significantly in emergency PCI group compared with elective PCI group(3.77%,16.98%,11.32% and 18.87%).Conclusions For STEMI patients,emergency interventional treatment can rapidly improve myocardial ischemia and reperfusion,then relieve symptoms of myocardial ischemia,reduce incidence of recurrent infarction and mortality.

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刘卫其,张励庭,黄炫生,袁勇,冯力,张劲,吴颖,韩莹,黎洁雯.急性ST段抬高型心肌梗死的急诊介入治疗与择期介入治疗预后对比[J].中国动脉硬化杂志,2011,19(9):781~784.

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  • 收稿日期:2011-05-12
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