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目的评价脉压与急性ST段抬高型心肌梗死(ASTEMI)患者行经皮冠状动脉介入术(PCI)近期疗效的关系。方法回顾性分析2011年1月至2015年6月ASTEMI行PCI治疗的患者389例,根据脉压分为A组:脉压≤20mm Hg,n=122;B组:脉压20~60mm Hg,n=138;C组:脉压>60mm Hg,n=129。观察不同脉压组患者冠状动脉病变严重程度;PCI术前、术后罪犯血管心肌梗死溶栓试验(TIMI)的血流情况,恶性心律失常的发生情况;观察血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTn-I)、血浆氨基末端脑钠尿肽前体(NT-proBNP)峰值情况;对比术后1周6min步行距离;对比术后1周死亡情况;对比PCI术后1周与术前脉压的变化。结果冠状动脉病变累及血管数与累及部位由轻及重依次为B组、C组、A组(均P<0.05);3组罪犯血管PCI术前血流情况差异有统计学意义,B组优于C组,更优于A组(均P<0.05),PCI术后差异无统计学意义(均P>0.05)。术中、术后恶性心律失常的发生由少到多依次为B组、C组、A组,3组间差异有统计学意义(P<0.05)。PCI术后CK-MB、cTn-I、NT-proBNP峰值3组间对比均表现为B组C组>B组,3组间差异有统计学意义(均P<0.05)。心源性休克是A组最重要的死亡原因,但3组间心源性死亡病因发生情况无统计学意义(均P>0.05)。PCI术后A组脉压取得明显有益的改善。结论脉压对ASTEMI患者PCI近期预后有一定的预测作用。
Objective To evaluate the relationship between pulse pressure and the short-term efficacy of percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Methods A retrospective analysis of 389 patients with PCI underwent ASTEMI from January 2011 to June 2015 was divided into group A according to pulse pressure: pulse pressure ≤20 mm Hg, n = 122; group B: pulse pressure 20-60 mm Hg, n = 138; Group C: pulse pressure> 60 mm Hg, n = 129. To observe the severity of coronary artery disease in patients with different pulse pressure group; the blood flow of thrombolytic test (TIMI) and the incidence of malignant arrhythmia before and after PCI; the changes of serum creatine kinase (CK) -MB, cTn-I and NT-proBNP were measured. The distance of 6-minute walking at 1 week after surgery was compared with that at 1 week after surgery. Changes of PCI and preoperative pulse pressure during 1 week after PCI. Results The number of vessels involved in the lesion of coronary artery and the lesion involved were light and heavy in order of Group B, Group C and Group A (all P <0.05). There were significant differences among the three groups in blood flow before PCI In group C, it was better than group A (both P <0.05). There was no significant difference after PCI (all P> 0.05). Intraoperative and postoperative malignant arrhythmia occurred in ascending order of B group, C group, A group, the difference between the three groups was statistically significant (P <0.05). The peak values of CK-MB, cTn-I and NT-proBNP in the three groups after PCI were all significantly lower in group B than those in group C C group> B group, the difference between the three groups was statistically significant (P <0.05). Cardiogenic shock was the most important cause of death in group A, but there was no significant difference in the causes of cardiac death among the three groups (all P> 0.05). A group of PCI pulse after the significant improvement achieved. Conclusions Pulse pressure has some predictive value on the prognosis of PCI in ASTEMI patients.