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远隔缺血后适应改善STEMI患者临床预后及卫生经济学评价
作者:
作者单位:

(新疆医科大学第一附属医院心脏中心,新疆乌鲁木齐市 830001)

作者简介:

阿依古再丽·图尔贡,硕士研究生,研究方向为心脏内科,E-mail为978417757@qq.com。通信作者杨毅宁,博士,主任医师,教授,博士研究生导师,研究方向为心血管基础与介入临床,E-mail为yangyn5126@163.com。通信作者李晓梅,博士,主任医师,教授,博士研究生导师,研究方向为心血管疾病的基础与临床研究,E-mail为lixm505@163.com。

基金项目:

国家重点研发计划项目(2018YFC1312804)；国家自然科学基金项目(81660058)；自治区创新条件(人才、基地)建设专项(科技创新基地建设计划-重点实验室建设)(2018D03029)


Clinical study and health economics evaluation of remote ischemic postconditioning to improve the prognosis of patients with STEMI
Author:
Affiliation:

Heart Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830001, China)

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    摘要:

    目的 研究远隔缺血后适应(RIPostC)对接受直接经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者临床预后的影响并进行卫生经济学评价。方法 该研究为前瞻性研究,连续入选2016年2月—2018年10月在新疆医科大学第一附属医院诊断为STEMI且急诊行直接PCI的患者309例。按照随机数字表分为RIPostC组(n＝155)和对照组(n＝154),RIPostC组患者行直接PCI术前完成三轮下肢缺血后适应。比较两组患者肌酸激酶同工酶(CK-MB)曲线下面积(AUC)、院内主要不良心脏事件(MACE)和直接医疗费用。院外平均随访1.5年,比较两组患者院外MACE发生率及再入院花费的直接医疗费用。结果 RIPostC组入院48 h内CK-MB累积释放量低于对照组(P＜0.05)。RIPostC组院内总MACE发生率低于对照组(P＜0.05)。RIPostC组院外总MACE发生率低于对照组(P＜0.05),其中院外死亡率低于对照组(P＜0.05)。通过Kaplan-Meier曲线比较两组患者MACE事件累计发生率的情况,结果显示PCI术后50天后Kaplan-Meier曲线明显出现分离,RIPostC组院外总MACE累计发生率低于对照组(P＜0.05)。RIPostC组住院期间及再入院花费的直接医疗费用均低于对照组(P＜0.05)。结论 RIPostC作为PCI治疗过程的辅助治疗,不仅能改善STEMI患者临床预后,还能减轻患者经济负担。

    Abstract:

    Aim To study the effect of remote ischemic postconditioning (RIPostC) on the clinical prognosis of patients with ST-segment elevation myocardial infarction (STEMI) who received direct percutaneous coronary intervention (PCI) and to evaluate the health economics. Methods A total of 309 patients with STEMI diagnosed in the First Affiliated Hospital of Xinjiang Medical University from February 2016 to October 2018 were enrolled in this prospective study.According to the random number table, the patients were divided into two groups:the RIPostC group (n＝155) and the control group (n＝154). Patients in RIPostC group completed three rounds of ischemic postconditioning of lower extremities before direct PCI. The area under creatine kinase isoenzyme (CK-MB), major adverse cardiac events (MACE) and direct medical expenses were compared between the two groups. The average out-of-hospital follow-up was 1.5 years. The incidence of out-of-hospital MACE and the direct medical expenses of re-admission were compared between the two groups. Results The cumulative release of CK-MB within 48 hours after admission in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05), and the out-of-hospital mortality rate was lower than that in the control group (P＜0.05). The cumulative incidence of MACE events in the two groups was compared by Kaplan-Meier curve. The results showed that the Kaplan-Meier curve was significantly separated 50 days after PCI, and the cumulative incidence of out-of-hospital total MACE in the RIPostC group was lower than that in the control group (P＜0.05). The direct medical expenses during hospitalization and re-admission in the RIPostC group were lower than those in the control group (P＜0.05), respectively. Conclusion As an adjuvant therapy in the treatment of PCI, RIPostC can not only improve the clinical prognosis of patients with STEMI, but also reduce the economic burden of patients.

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引用本文

阿依古再丽·图尔贡,赵倩,刘芬,宋宁,张雪鹤,杨毅宁,李晓梅.远隔缺血后适应改善STEMI患者临床预后及卫生经济学评价[J].中国动脉硬化杂志,2021,29(6):512~518.

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  • 收稿日期:2020-12-15
  • 最后修改日期:2021-03-16
  • 在线发布日期: 2021-06-11

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