本文選題：急性ST抬高心肌梗塞 + 經(jīng)皮冠狀動脈介入治療��； 參考：《桂林醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的：比較血栓抽吸(thrombus aspiration)加常規(guī)急診經(jīng)皮冠狀動脈冠狀動脈介入（percutaneous coronary intervensions，PCI）和單純常規(guī)急診PCI兩種方法對急性ST段抬高心肌梗死(STEMI)患者術(shù)后血漿氨基末端腦利鈉肽前體(N-terminal pro-brainnatriureticpeptide，NT-proBNP)水平及左室功能及預(yù)后的影響，以期進一步探討血栓抽吸改善STMI患者預(yù)后的機理，為冠心病的治療提供有價值的參考依據(jù)。方法：入選2009年8月-2012年10月期間在我院住院診斷為STEMI并行急診PCI的患者80例，隨機分為以下2組：(1)單純介入治療組（常規(guī)PCI組）：40例，(2)血栓抽吸組+支架置入組（血栓抽吸+常規(guī)PCI組）:40例。比較：⑴兩組術(shù)后即刻心肌梗死溶栓治療(TIMI)血流分級；(2)兩組術(shù)后即刻、術(shù)后48小時、術(shù)后3月、術(shù)后6月的NT-proBNP水平；（3）術(shù)后肌酸激酶同工酶(CK-MB)、肌鈣蛋白I(cTnI)及超敏C反應(yīng)蛋白（hs-CRP）的峰值和達(dá)峰時間；（4）術(shù)后3天和6月心臟功能情況：使用心臟多譜勒超聲心動圖測量左室舒張末期容積（LVEDV）、左室收縮末期容積(LVESV)、每搏量(SV)、左室射血分?jǐn)?shù)（LVEF)；（5）術(shù)后血管不良事件(major adverse cardiovascular events，MACE)的發(fā)生情況。結(jié)果：1.入院即刻肘靜脈血與罪犯冠狀動脈血中NT-proBNP（pg/mL）對比:1804.8士951.3vs1911.8士851.3，無統(tǒng)計學(xué)差異，P＞0.05。血栓抽吸組與對照組相比，入院即刻NT-proBNP無統(tǒng)計學(xué)差異，術(shù)后48小時877.6±651.2vs1316.7±799.6，術(shù)后3月123.8±64.2vs188.7±82.4，術(shù)后6月113.4±44.1vs177.5±79.2，血栓抽吸組均低于對照組，差異有統(tǒng)計學(xué)意義，P＜0.05。2.兩組患者出現(xiàn)TIMI0-1級例數(shù)：在血栓抽吸組1例(2.5%)，而對照組出現(xiàn)8例(20%)。差異有統(tǒng)計學(xué)意義(P＜0.05)。出現(xiàn)TIMI2級例數(shù)兩組相近10%vs17.5%，差異無統(tǒng)計學(xué)意義，P＞0.05。出現(xiàn)TIMI3級例數(shù)血栓抽吸組明顯多于對照組，87.5%vs52.5%,差異有統(tǒng)計學(xué)意義，P0.05。3.心臟彩超測量心功能：PCI術(shù)后3天血栓抽吸組患者左心功能各參數(shù)略好于對照組，但差異無統(tǒng)計學(xué)意義，P＞0.05。PCI術(shù)后6個月時血栓抽吸組左室舒張末期容積（LVEDV）（84.68±12.95vs98.32±18.49）、每搏量（SV）（52.41±8.18vs46.63±7.18）、左室射血分?jǐn)?shù)（LVEF）（61.25±10.05vs47.15±5.05）較對照組明顯改善，，差異有統(tǒng)計學(xué)意義，P＜0.05。4.血栓抽吸組與對照組相比，肌酸激酶同工酶（CK-MB）峰值（187.1±64.3vs221.6±56.1）、肌鈣蛋白I（cTnI）峰值（28.2±15.9vs41.2±19.3）、超敏C反應(yīng)蛋白（hs-CRP）峰值（26.4±20.8vs46.4±22.7）均降低，肌酸激酶同工酶（CK-MB）達(dá)峰時間提前（9.8±6.5vs13.1±5.5）差異有統(tǒng)計學(xué)意義（P0.05)。5.術(shù)后6個月觀察終點比較（MACE）：血栓抽吸組和對照組相比，有減少趨勢，但無統(tǒng)計學(xué)差異（P0.05）。結(jié)論：1.顯示抽吸導(dǎo)管抽合并常規(guī)PCI治療較常規(guī)PCI可明顯改善TIMI血流分級，減少冠脈“無復(fù)流”或“慢血流”。2.抽吸導(dǎo)管抽合并常規(guī)PCI治療較常規(guī)PCI可降低NT-proBNP表達(dá)。3.抽吸導(dǎo)管抽合并常規(guī)PCI治療較常規(guī)PCI可明顯改善心肌組織灌注水平，改善左心功能，減少心室重構(gòu)發(fā)生。
[Abstract]:Objective: to compare the effect of thrombus aspiration plus percutaneous coronary intervention (PCI) and percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) after operation of plasma amino-terminal brain natriuretic peptide (ACTNP) in patients with acute ST-segment elevation myocardial infarction (STEMI). The effects of N-terminal N-terminal NT-proBNPs on the left ventricular function and prognosis, NT-proBNPs, NT-proBNPs, and NT-proBNPs. To further explore the mechanism of thrombotic aspiration to improve the prognosis of patients with STMI, and to provide a valuable reference for the treatment of coronary heart disease. Methods: from August 2009 to October 2012, 80 patients with STEMI and emergency PCI were enrolled in our hospital. They were randomly divided into the following two groups: intervention group (routine PCI group, n = 40), thrombus aspiration group (n = 40, n = 40), thrombotic aspiration group (n = 40), thrombotic aspiration group (n = 40), conventional PCI group (n = 40, n = 40). Comparison of immediate thrombolytic therapy of myocardial infarction with thrombolytic therapy in two groups (TIMI2): immediately after operation, 48 hours after operation, and 3 months after operation, the two groups were treated with thrombolytic therapy. The peak value of creatine kinase isoenzyme (CK-MBN), cardiac troponin I (cTnI) and hypersensitive C-reactive protein hs-CRP (hs-CRP) in 6 months after operation were measured by echocardiography 3 days and 6 months after operation. Left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEF). The result is 1: 1. There was no significant difference in NT-proBNPP PG / mL between NT-proBNPpg / mL (1808 + 951.3vs1911.8 = 851.3, P > 0.05) immediately after admission, and no significant difference was found between the two groups (P > 0.05). There was no significant difference in NT-proBNP between the thrombotic aspiration group and the control group. At 48 hours after operation, 877.6 鹵651.2vs1316.7 鹵799.6, 123.8 鹵64.2vs188.7 鹵82.4 at 3 months after operation and 113.4 鹵44.1vs177.5 鹵79.2 at 6 months after operation, the NT-proBNP in the thrombotic aspiration group was lower than that in the control group (P < 0.05.2). The number of TIMI0-1 grade cases in the two groups: one case in the thrombotic aspiration group and one case in the thrombotic aspiration group, and 8 cases in the control group. The difference was statistically significant (P < 0.05). The number of TIMI2 cases in the two groups was similar to 10 vs 17. 5, the difference was not statistically significant (P > 0. 05). The number of TIMI3 patients in the thrombotic aspiration group was significantly higher than that in the control group (87.5 vs 52.5), and the difference was statistically significant (P 0.05.3). The parameters of left ventricular function in the thrombotic aspiration group were slightly better than those in the control group 3 days after PCI by color Doppler echocardiography. However, there was no significant difference in left ventricular end-diastolic volume (LVEDVV), 52.41 鹵8.18vs46.63 鹵7.18g / L, 61.25 鹵10.05vs47.15 鹵5.05 left ventricular ejection fraction (LVEF) in the thrombotic aspiration group at 6 months after 0.05.PCI (P < 0.05.4), but there was no significant difference in the left ventricular end-diastolic volume (LVEVV), 52.41 鹵8.18vs46.63 鹵7.18g / L and 61.25 鹵10.05vs47.15 鹵5.05 (P < 0.05.4) in the thrombotic aspiration group (P > 0.05), which was significantly higher than that in the control group (P < 0.05). Compared with the control group, the peak value of creatine kinase isoenzyme CK-MBs was 187.1 鹵64.3vs221.6 鹵56.1g, the peak value of troponin I cTnI was 28.2 鹵15.9vs41.2 鹵19.3g, and the peak value of hs-CRPs was 26.4 鹵22.7. the peak time of creatine kinase isoenzyme CK-MBwas increased by 9.8 鹵6.5vs13.1 鹵5.5. there was significant difference in the peak time of creatine kinase isoenzyme (CK-MBB). At 6 months after operation, the end points were observed and compared: compared with the control group, the thrombotic aspiration group had a decreasing trend, but there was no statistical difference (P 0.05). Conclusion 1. The results showed that aspiration catheter combined with conventional PCI therapy could significantly improve the grading of TIMI blood flow and reduce coronary "no reflow" or "slow blood flow" .2compared with routine PCI. Aspiration catheter aspiration combined with conventional PCI therapy can reduce the expression of NT-proBNP. 3. 3. Compared with routine PCI, aspiration catheter drainage combined with conventional PCI can significantly improve myocardial perfusion, improve left ventricular function and reduce ventricular remodeling.
【學(xué)位授予單位】：桂林醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R542.22

【參考文獻】

相關(guān)期刊論文 前2條

1 何奔;丁嵩;卜軍;劉建平;宋瑋;杜勇平;沈節(jié)艷;金叔宣;孫瑜;沈瓏;;腦利鈉肽和C-反應(yīng)蛋白在急性冠狀動脈綜合征介入治療患者的預(yù)后價值[J];中華心血管病雜志;2006年04期

2 姚宇;趙雅琳;;BNP與冠心病危險因素的相關(guān)性[J];中國誤診學(xué)雜志;2011年03期

本文編號：1854850