本文選題：無(wú)復(fù)流現(xiàn)象 + ST段抬高型心肌梗死��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的在發(fā)病12小時(shí)內(nèi)接受緊急P(pán)CI術(shù)的急性ST段抬高型心肌梗死患者中,對(duì)比支架植入術(shù)后無(wú)復(fù)流組與正常血流組相關(guān)指標(biāo)是否存在統(tǒng)計(jì)學(xué)差異,確定該類(lèi)患者PCI術(shù)后無(wú)復(fù)流現(xiàn)象發(fā)生的獨(dú)立危險(xiǎn)因素,希望能夠?yàn)榻窈鬅o(wú)復(fù)流現(xiàn)象的臨床防治工作提供相關(guān)參考依據(jù)。方法回顧性研究因急性STEMI入院,在發(fā)病12小時(shí)之內(nèi)接受緊急P(pán)CI的患者共411例。依據(jù)術(shù)后TIMI血流評(píng)判方法將所有患者分為兩組:無(wú)復(fù)流組(TIMI血流分級(jí)為0、1、2級(jí)者并入該組),正常血流組(TIMI血流分級(jí)為3級(jí)者入該組)。收集所有患者的基本臨床資料:年齡、性別、吸煙史、飲酒史、高血壓史、糖尿病史、腦血管病史、冠心病家族史、梗死前心絞痛、入院時(shí)發(fā)病時(shí)間、再灌注時(shí)間、收縮壓、舒張壓、Killip分級(jí)、ST段最大抬高幅度、術(shù)后1小時(shí)ST段回落程度、病理性Q波導(dǎo)聯(lián)數(shù)。收集患者化驗(yàn)指標(biāo):白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、淋巴細(xì)胞百分比、血小板計(jì)數(shù)、平均血小板體積、血小板分布寬度、肌酐、尿酸、肌酸激酶、肌酸激酶同工酶、超敏肌鈣蛋白T、B型利納肽前體、空腹血糖、載脂蛋白A、載脂蛋白B、超敏C反應(yīng)蛋白、同型半胱氨酸、總膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白。收集患者冠脈造影資料:PCI術(shù)前TIMI血流分級(jí)、PCI靶血管、側(cè)支循環(huán)、血栓、術(shù)中最大擴(kuò)張壓力、球囊擴(kuò)張時(shí)間、預(yù)擴(kuò)張次數(shù)、支架內(nèi)擴(kuò)張次數(shù)、后擴(kuò)張次數(shù)、血栓抽吸、IABP的應(yīng)用。收集患者術(shù)后MACE事件出現(xiàn)情況:術(shù)后AMI、血流動(dòng)力學(xué)不穩(wěn)定需再次手術(shù)、住院期間死亡。選擇合適的統(tǒng)計(jì)學(xué)方法對(duì)無(wú)復(fù)流組與正常血流組患者的所有資料進(jìn)行比較分析,判斷有無(wú)統(tǒng)計(jì)學(xué)差異,明確12小時(shí)內(nèi)行緊急P(pán)CI的急性STEMI患者術(shù)后出現(xiàn)無(wú)復(fù)流現(xiàn)象的獨(dú)立危險(xiǎn)因素。結(jié)果(1)本研究中無(wú)復(fù)流組患者共113例(男性82例,女性31例),正常血流組患者共298例(男性230例,女性68例),PCI術(shù)后無(wú)復(fù)流現(xiàn)象發(fā)生的概率27.5%。(2)通過(guò)比較基本臨床資料,可以得出結(jié)果:兩組患者在入院時(shí)發(fā)病時(shí)間、再灌注時(shí)間、收縮壓、Killip分級(jí)、ST段最大抬高幅度、術(shù)后1小時(shí)ST段回落程度、病理性Q波導(dǎo)聯(lián)數(shù)方面具有顯著性差異,余指標(biāo)沒(méi)有顯著性差異。(3)通過(guò)比較化驗(yàn)指標(biāo)資料,可以得出結(jié)果:兩組患者在白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、淋巴粒細(xì)胞百分比、肌酸激酶、肌酸激酶同工酶、超敏肌鈣蛋白T、B型利納肽前體方面具有顯著性差異,余指標(biāo)沒(méi)有顯著性差異。(4)通過(guò)比較冠脈造影資料,可以得出結(jié)果:兩組患者在PCI術(shù)前TIMI血流分級(jí)、PCI靶血管、無(wú)側(cè)支循環(huán)、血栓、血栓抽吸方面具有顯著性差異,余指標(biāo)沒(méi)有顯著性差異。(5)通過(guò)比較術(shù)后MACE事件發(fā)生情況,可以得出結(jié)果:兩組患者術(shù)后均未發(fā)生AMI,在血流動(dòng)力學(xué)不穩(wěn)定需再次手術(shù)、住院期間死亡方面沒(méi)有顯著性差異。(6)將所有資料進(jìn)行Logistic回歸分析得出結(jié)果:入院時(shí)發(fā)病時(shí)間、再灌注時(shí)間、ST段抬高最大幅度、病理Q波導(dǎo)聯(lián)數(shù)、白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、肌酸激酶同工酶、超敏肌鈣蛋白T、無(wú)側(cè)支循環(huán)是無(wú)復(fù)流現(xiàn)象的獨(dú)立危險(xiǎn)因素結(jié)論(1)無(wú)復(fù)流發(fā)生率27.5%。(2)入院時(shí)發(fā)病時(shí)間、再灌注時(shí)間、收縮壓、Killip分級(jí)、ST段最大抬高幅度、術(shù)后1小時(shí)ST段回落程度、病理性Q波導(dǎo)聯(lián)數(shù)、白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、淋巴粒細(xì)胞百分比、肌酸激酶、肌酸激酶同工酶、超敏肌鈣蛋白T、B型利納肽前體、PCI術(shù)前TIMI血流分級(jí)、PCI靶血管、無(wú)側(cè)支循環(huán)、血栓、血栓抽吸與無(wú)復(fù)流現(xiàn)象具有明顯相關(guān)性。(3)入院時(shí)發(fā)病時(shí)間、再灌注時(shí)間、ST段抬高最大幅度、病理Q波導(dǎo)聯(lián)數(shù)、白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、肌酸激酶同工酶、超敏肌鈣蛋白T、無(wú)側(cè)支循環(huán)這幾方面是12小時(shí)內(nèi)行緊急P(pán)CI的急性STEMI患者術(shù)后出現(xiàn)無(wú)復(fù)流現(xiàn)象的獨(dú)立危險(xiǎn)因素。(4)縮短再灌注時(shí)間能夠降低無(wú)復(fù)流現(xiàn)象發(fā)生率。
[Abstract]:Objective to determine whether there is a statistical difference between the non reflow group and the normal blood flow group after the stent implantation for acute ST segment elevation myocardial infarction within 12 hours of the onset of PCI, and to determine the independent risk factor for no reflow phenomenon after PCI operation in this type of patient, and hope to be a clinical non reflow phenomenon in the future. Methods the prevention and control work provided the reference basis. Methods a retrospective study of 411 patients receiving emergency PCI within 12 hours of onset of acute STEMI was reviewed. All patients were divided into two groups according to the postoperative TIMI flow evaluation method: no reflow group (TIMI blood flow classification as 0,1,2 group), and normal blood flow group (TIMI blood flow classification was grade 3) The basic clinical data of all patients: age, sex, smoking history, history of hypertension, hypertension, diabetes history, cerebrovascular history, family history of coronary heart disease, pre infarction angina, time of hospitalization, reperfusion time, systolic pressure, diastolic pressure, Killip classification, ST segment maximum elevation, 1 hours ST segment decline after operation, pathology, pathology, pathology, and pathology. Sex Q waveguide couplets. Collection of patient test indexes: leukocyte count, percentage of neutrophils, lymphocyte percentage, platelet count, average platelet volume, platelet distribution width, creatinine, uric acid, creatine kinase, creatine kinase isoenzyme, hypersensitivity troponin T, B type linapelin precursor, fasting blood glucose, apolipoprotein A, apolipoprotein B, B, super C reactive protein, homocysteine, total cholesterol, triglyceride, triglycerides, high-density lipoprotein, low density lipoprotein. Collection of patients with coronary angiography: preoperative TIMI blood flow classification, PCI target vessel, collateral circulation, thrombus, maximum dilation pressure, balloon dilatation time, number of predilatation, number of dilatation in stents, post dilatation times, thrombus extraction Aspiration, the application of IABP. Collect the occurrence of postoperative MACE events in patients: postoperative AMI, hemodynamic instability need to be reoperated and hospitalized. Choose appropriate statistical methods to compare and analyze all data in the non reflow group and the normal blood flow group, to determine whether there is any statistical difference, and to clarify the acute ST for emergency PCI in 12 hours. EMI patients had independent risk factors without reflow after operation. Results (1) there were 113 patients without reflow group (82 males and 31 females), 298 cases in normal blood flow group (230 men, 68 women), the probability of no reflow phenomenon after PCI (2) through comparison of basic clinical data, the results could be obtained in two groups of patients. The onset time, reperfusion time, systolic blood pressure, Killip classification, ST segment maximum elevation, 1 hours ST segment decline degree after operation, pathological Q waveguides have significant differences, and there is no significant difference in the residual index. (3) the results can be obtained by comparing the data of the test index: the two groups of patients are in leukocyte count, neutrophils Percentage, percentage of lymphogranulocyte, creatine kinase, creatine kinase isoenzyme, hypersensitive troponin T, B type linactin precursors, there were significant differences, and there was no significant difference in the residual index. (4) the results were obtained by comparing the data of coronary angiography: the two groups were graded before PCI, PCI target vessel, no collateral circulation, thrombus, There was significant difference in thrombus aspiration, and there was no significant difference in the residual index. (5) by comparing the occurrence of MACE events after the operation, the results were obtained: the two groups had no AMI after operation, the reoperation needed to be reoperated in the hemodynamic instability and there was no significant difference in death during the hospitalization. (6) all the data were divided into Logistic regression. The results were as follows: the time of admission, the time of reperfusion, the maximum elevation of ST segment, the number of pathological Q waveguides, the white blood cell count, the percentage of neutrophils, the creatine kinase isozyme, the hypersensitivity troponin T, the no collateral circulation is an independent risk factor for no reflow phenomenon (1) the incidence of no reflow rate of 27.5%. (2), and reperfusion time. Time, systolic pressure, Killip grade, ST segment maximum elevation, 1 hours ST segment drop, pathological Q waveguide couplet, leukocyte count, neutrophil percentage, lymphogranulocyte percentage, creatine kinase, creatine kinase isoenzyme, hypersensitive troponin T, B type leninin precursor, PCI preoperative TIMI blood flow classification, PCI target vessel, unlateral There was a significant correlation between the branched circulation, thrombus, thrombus aspiration and no reflow. (3) the time of admission, the time of reperfusion, the maximum elevation of ST segment elevation, the number of pathological Q waveguides, the white cell count, the percentage of neutrophils, the creatine kinase isoenzyme, the hypersensitivity muscle calcium egg white T, and the non collateral circulation are the acute PCI acute in several aspects. STEMI patients had independent risk factors for no reflow after operation. (4) shortening reperfusion time could reduce the incidence of no reflow phenomenon.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 袁馳;柯永勝;柯可;;急性ST段抬高型心肌梗死患者行急診PCI無(wú)復(fù)流的危險(xiǎn)因素分析[J];中國(guó)循證心血管醫(yī)學(xué)雜志;2016年11期

2 王如珠;殷屹崗;朱莉;林杰;李建民;王斌;;經(jīng)抽吸導(dǎo)管冠狀動(dòng)脈內(nèi)注射替羅非班對(duì)急診介入治療無(wú)復(fù)流的影響[J];中華老年心腦血管病雜志;2015年10期

3 王軍;華琦;李康;王麗;范振興;王艷玲;李博宇;譚靜;李靜;;血清炎性標(biāo)記物對(duì)急性心肌梗死患者冠狀動(dòng)脈介入術(shù)后無(wú)復(fù)流的預(yù)測(cè)價(jià)值[J];中華老年心腦血管病雜志;2015年10期

4 Hua Zhou;Xiao-yan He;Shao-wei Zhuang;Juan Wang;Yan Lai;Wei-gang Qi;Yi-an Yao;Xue-bo Liu;;Clinical and procedural predictors of no-ref low in patients with acute myocardial infarction after primary percutaneous coronary intervention[J];World Journal of Emergency Medicine;2014年02期

5 戴敬;呂樹(shù)錚;宋現(xiàn)濤;柳弘;;介入術(shù)后無(wú)復(fù)流現(xiàn)象的研究進(jìn)展[J];心肺血管病雜志;2014年01期

6 孫王樂(lè)賢;趙潔;劉會(huì)玲;單偉超;張英;郭金銳;孫靜;李春華;;急性前壁ST段抬高心肌梗死患者的心電圖表現(xiàn)及心肌酶峰與近期左心功能的相關(guān)性[J];中華醫(yī)學(xué)雜志;2014年03期

7 王云川;常學(xué)鋒;劉國(guó)輝;陶貴周;;SYNTAX評(píng)分對(duì)急性心肌梗死患者急診PCI術(shù)后無(wú)復(fù)流現(xiàn)象的預(yù)測(cè)價(jià)值[J];中國(guó)老年學(xué)雜志;2014年01期

8 彭暉;文錕;王明建;李孟常;;cTnI聯(lián)合心肌酶檢測(cè)在急性心肌梗死診斷中的意義[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2010年11期

9 賈大林;李麗麗;齊國(guó)先;;AMI急診PCI支架術(shù)后無(wú)復(fù)流現(xiàn)象的臨床分析[J];醫(yī)學(xué)臨床研究;2008年11期

10 蘇軍紅;劉君;傅向華;李世強(qiáng);谷新順;薛玲;趙運(yùn)濤;;急性心肌梗死患者經(jīng)皮冠狀動(dòng)脈介入治療后無(wú)復(fù)流現(xiàn)象的臨床特點(diǎn)及其對(duì)心室功能的影響[J];臨床心血管病雜志;2006年10期

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