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目的:探讨比索洛尔干预对于急性冠脉综合征(acute coronary syndrome,ACS)患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后QRS-T转角改变及其临床意义。方法:连续纳入100例ACS患者,急诊PCI术开通罪犯血管,术后分为比索洛尔组和常规治疗组。另选50名年龄相似,非冠心病志愿者作为对照组。观察术前和术后额面QRS-T夹角情况与术后1年主要心脏不良事件(major adverse cardiovascular events,MACE)发生率的相关性。结果:ACS患者PCI术前额面QRS-T夹角均明显高于对照组(F=4.528,P=0.033)。在急诊PCI后第三天可见比索洛尔组ACS患者额面QRS-T夹角明显回落(74.9±11.2°vs.50.3±15.2°,P<0.05)。比索洛尔治疗与ACS患者急诊PCI术后额面QRS-T夹角改变(r=0.783,P=0.013)成正相关,而与MACE发生率(r=-0.512,P=0.034)存在负相关。ACS患者急诊PCI术后使用早期加用比索洛尔治疗后可以使MACE发生风险降低23%(P=0.012)、△额面QRS-T夹角(每增加1°)使MACE风险降低8%(P=0.041),而Gensini评分(每增加1分)使MACE发生风险升高32%(P=0.035)。结论:ACS患者PCI术后早期应用比索洛尔治疗可以促进额面QRS-T夹角水平回落。额面QRS-T夹角回落幅度与MACE的发生相关。
Objective: To investigate the changes and clinical significance of bisoprolol intervention for QRS-T after acute percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: A total of 100 patients with ACS were enrolled in this study. Emergency angiography was performed in patients undergoing PCI. The patients were divided into bisoprolol group and conventional treatment group. Another 50 age-matched, non-coronary heart disease volunteers as a control group. The relationship between the preoperative and postoperative frontal QRS-T angle and incidence of major adverse cardiovascular events (MACE) at 1 year after operation was observed. Results: The angle of QRS-T of preoperative PCI in patients with ACS was significantly higher than that of the control group (F = 4.528, P = 0.033). On the third day after emergency PCI, the angle of QRS-T of forehead in patients with bisoprolol was significantly decreased (74.9 ± 11.2 ° vs. 50.3 ± 15.2 °, P <0.05). There was a positive correlation between bisoprolol treatment and QRS-T elevation (r = 0.783, P = 0.013) in patients with ACS after emergency PCI, but negatively correlated with the incidence of MACE (r = -0.512, P = 0.034) The risk of MACE was reduced by 23% (P = 0.012) and the delta frontal QRS-T angle (1 ° for each additional increase) was associated with a MACE risk reduction of 8% in ACS patients treated with early PCI (early bisoprolol treatment) P = 0.041), while the Gensini score (1 point increase) increased the risk of MACE by 32% (P = 0.035). Conclusion: The early use of bisoprolol after PCI in patients with ACS can promote the level of QRS-T elevation of frontal plane. Frontal QRS-T angle between the rate of decline and the occurrence of MACE.