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目的探讨急性心肌梗死(AMI)行急诊经皮冠状动脉介入(PCI)治疗后心肌再灌注不良及其对临床预后的影响。方法回顾性分析68例AMI急诊PCI治疗患者(36-85岁)的临床资料。以ST段回落程度与心肌梗死溶栓治疗心肌灌注分级评估心肌组织再灌注状态,并将患者分为四组:A组27例(39.7%),再灌注良好;D组10例(14.7%),再灌注不良;B组20例(29.4%)和C组11例(16.2%)的再灌注状态介于A、D组之间。分析随访期间严重心血管不良事件(SCAE)的发生风险。结果与A组比较,D组患者的左室射血分数低、梗死后心绞痛和远端栓塞发生率高、应用主动脉内气囊反搏辅助者比率增加、住院时间长、心源性病死率高(P<0.05)。以D组作为参照绘制生存曲线显示,A组随访期间SCAE的发生风险为2.7%(P<0.01),C和B组分别为43.0%(P>0.05)和24.0%(P<0.01)。结论 AMI行急诊PCI治疗后致病血管再通者中,仅有不到40%患者的心肌组织得到了良好的再灌注,近、远期预后较好;有超过10%的患者心肌组织处于较差的再灌注状态,存在极高的SCAE发生风险。
Objective To investigate the effect of acute myocardial infarction (AMI) on myocardial reperfusion after emergency percutaneous coronary intervention (PCI) and its impact on clinical prognosis. Methods A retrospective analysis of 68 patients with AMI emergency PCI treatment of patients (36-85 years old) clinical data. The level of ST segment depression and myocardial infarction thrombolysis myocardial perfusion grading assessment myocardial tissue reperfusion status, and the patients were divided into four groups: A group of 27 patients (39.7%), reperfusion well; D group of 10 patients (14.7% , And reperfusion was poor. The reperfusion status of 20 cases (29.4%) in group B and 11 cases (16.2%) in group C were between A and D groups. The risk of serious cardiovascular adverse events (SCAE) during follow-up was analyzed. Results Compared with group A, patients in group D had a lower incidence of left ventricular ejection fraction, a higher incidence of post-infarction angina pectoris and distal embolism, increased intra-aortic balloon counterpulsation, increased length of hospital stay, and high cardiac-mortality (P <0.05). According to the survival curve of group D, the risk of SCAE was 2.7% (P <0.01) in group A and 43.0% (P <0.05) and 24.0% (P <0.01) in group C and B, respectively. Conclusions Among less than 40% of patients with AMI undergoing PCI after PCI, the myocardial tissue is well reperfused and the short-term and long-term prognosis is good. More than 10% Poor reperfusion status, there is a high risk of SCAE.