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目的观察急诊经皮冠状动脉介入治疗(percutaneous transluminal coronary intervention,PCI)中脉搏血氧饱和度水平与急性心肌梗死(acute myocardial infarction,AMI)患者临床疗效和预后的关系。方法选择进行急诊PCI的AMI患者132例,术中持续监测脉搏血氧饱和度(Sp O2),依据术中Sp O2水平将患者分为观察组(Sp O2<90%,n=64)和对照组(Sp O2≥90%,n=68)。所有患者均行急诊PCI治疗。观察两组患者冠状动脉血管病变支数,术后四周两组间的左室收缩末期容积(LVESV)、舒张末期容积(LVEDV)和左室射血分数(LVEF);两组患者住院期间、术后6个月内的主要心脏不良事件和6个月时的6分钟步行试验(six-minute walk test,6MWT)。结果观察组冠状动脉病变支数较对照组多[(1.9±0.9)vs(1.2±0.8),P<0.05)],前降支为梗死相关血管的比例多于对照组(62.6%vs 41.2%,P<0.05);术后4周观察组的LVESV、LVEDV较对照组高,LVEF较对照组低,差异有统计学意义。观察组6个月时的6 MWT距离较对照组短,且住院期间、术后6个月的主要不良心脏事件发生率较对照组高,差异有统计学意义。结论急诊PCI术中脉搏血氧饱和度水平是评价AMI患者临床疗效和预后的一种可靠指标。
Objective To observe the relationship between pulse oximetry and clinical efficacy and prognosis in patients with acute myocardial infarction (AMI) under emergency percutaneous transluminal coronary intervention (PCI). Methods Thirty-two AMI patients undergoing emergency PCI were enrolled in this study. SpO2 was continuously monitored during operation. The patients were divided into observation group (Sp O2 <90%, n = 64) and control group Group (Sp O2 ≥ 90%, n = 68). All patients underwent emergency PCI. The number of coronary artery lesions, the left ventricular end-systolic volume (LVESV), end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) between the two groups were observed after operation. Major adverse cardiac events within 6 months and 6-minute walk test (6MWT) at 6 months. Results The number of coronary lesions in the observation group was significantly higher than that in the control group (1.9 ± 0.9 vs 1.2 ± 0.8, P <0.05). The ratio of the anterior descending branch to the infarct-related artery was significantly higher than that of the control group (62.6% vs 41.2% , P <0.05). LVESV and LVEDV in the observation group were higher than those in the control group 4 weeks after operation, and LVEF was lower than that in the control group. The difference was statistically significant. The observation group at 6 months 6 MWT distance shorter than the control group, and during hospitalization, 6 months after the incidence of major adverse cardiac events than the control group, the difference was statistically significant. Conclusion The level of pulse oximetry in emergency PCI is a reliable indicator to evaluate the clinical efficacy and prognosis of patients with AMI.