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目的探讨缩短直接经皮冠状动脉介入治疗(PCI)开始时间对ST段抬高急性心肌梗死(STEMI)的临床价值。方法171例STEMI,根据发病到开始PCI时间分为3组:<3h(A组,43例),≥3h、<6h(B组,58例),≥6h、<12h(C组,70例)。其中18例应用远端保护装置。比较3组术后TIMI3级率、ST段无回落率、左心室射血分数和住院期间主要不良心脏事件发生率。结果A组术后TIMI3级率和左心室射血分数显著高于B组和C组,ST段无回落率和住院期间主要不良心脏事件发生率均显著低于B组和C组。B组和C组比较,各指标差异均无统计学意义。结论在STEMI直接PCI中,与3h后开始PCI比较,3h内PCI可显著提高TIMI3级率,改善心肌组织再灌注、心功能和近期预后;3h后介入治疗无明显的时间依赖性。
Objective To investigate the clinical value of shortening the time when PCI is started on STEMI. Methods A total of 171 STEMI patients were divided into 3 groups according to the time from the onset of PCI to the beginning of PCI: group A (n = 43), group A (n = 3), group C ). Among them 18 cases applied the far-end protection device. The TIMI3 grade, ST-segment non-drop rate, left ventricular ejection fraction and incidence of major adverse cardiac events during hospitalization were compared between the three groups. Results The postoperative TIMI3 grade and left ventricular ejection fraction in group A were significantly higher than those in group B and C, and the incidence of STD non-drop rate and major adverse cardiac events during hospitalization were significantly lower in group A than those in group B and group C. There was no significant difference between each group in B group and C group. Conclusion In STEMI direct PCI, PCI can improve TIMI3 grade and improve myocardial tissue reperfusion, cardiac function and short-term prognosis in 3 hours after PCI compared with 3 hours after PCI. There is no obvious time-dependent intervention in 3 hours after PCI.