经皮冠状动脉介入时机对急性心肌梗死后左室重构及心功能的影响
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摘要
目的探究经皮冠状动脉介入(PCI)手术时机对心肌梗死患者左室重构及心功能的影响。方法选本院收治的心肌梗死患者90例为研究对象,其中行急诊PCI术的45例为观察组,行择期PCI术的45例为对照组,分别于术前和术后1 d检测N末端前体脑利钠肽(NT-pro BNP)、去甲肾上腺素(NE)和肾上腺素(E)浓度、血浆肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)。于术后1周完善超声心动图,对比2组患者左室舒张末径(LVDEd)、左室收缩末径(LVSEd)、左房内径(LAd)和左室射血分数(LVEF)。随访6个月,对比2组心力衰竭发生率。结果 2组术前NT-proBNP、NE、E、PRA、AngⅡ、ALD水平差异无统计学意义(P>0.05);观察组术后1 d NT-proBNP、NE、E、PRA、AngⅡ、ALD水平均较术前和对照组降低,差异均有统计学意义(P<0.05)。术前2组LVDEd、LVSEd、LAd和LVEF差异无统计学意义(P>0.05);术后1个月,观察组LVDEd、LVSEd、LAd低于术前和对照组,LVEF高于术前和对照组,差异均有统计学意义(P<0.05)。观察组和对照组6个月内心梗后心力衰竭发病率分别为11.1%、24.4%,差异有统计学意义(χ~2=7.31,P<0.05)。结论经皮冠状动脉介入(PCI)手术时机的选择可影响心肌梗死患者预后,与择期PCI相比,急诊PCI可抑制RAAS系统和交感激活,改善心梗后心室重构和左室功能,降低继发性心力衰竭发病率。
Objective To investigate the effect of percutaneous coronary intervention( PCI)on left ventricular remodeling and cardiac function in patients with myocardial infarction. Methods A total of 90 myocardial infarction patients in our hospital were as the research objects,a total of 45 cases underwent PCI surgery were in observation group,another 45 cases undergoing elective PCI surgery were in control group. The levels of N-terminal pro brain natriuretic peptide( NT-pro BNP),norepinephrine( NE) and epinephrine( E),plasma renin( PRA),angiotensin Ⅱ( Ang Ⅱ),aldosterone( ALD) were detected before operation and on the first postoperative day. After 6 months of follow-up,the incidence of heart failure of two groups were compared. Results There was no significant difference between the two groups in preoperative NT-pro BNP,NE,E,PRA,Ang Ⅱ and ALD levels( P >0. 05),the observation group had decreased NT-pro BNP,NE,E,PRA,Ang Ⅱ,ALD levels at 1 d after operation than operation before and the control group( P < 0. 05). At 1 month after surgery,the observation group had lower LVDEd,LVSEd,LAd,and higher LVEF than treatment before and control group( P < 0. 05). The incidence of heart failure after 6 months in the observation group and the control group was 1 1. 1 %,2 4. 4 % respectively,and the difference was statistically significant( χ2= 7. 31,P < 0. 05). Conclusion Percutaneous coronary intervention( PCI) timing can affect the prognosis of patients with myocardial infarction. Compared with elective PCI,emergency PCI can inhibit the RAAS system and sympathetic activation,improve ventricular remodeling and left ventricular function after myocardial infarction,and reduce the incidence of secondary heart failure.
Objective To investigate the effect of percutaneous coronary intervention( PCI)on left ventricular remodeling and cardiac function in patients with myocardial infarction. Methods A total of 90 myocardial infarction patients in our hospital were as the research objects,a total of 45 cases underwent PCI surgery were in observation group,another 45 cases undergoing elective PCI surgery were in control group. The levels of N-terminal pro brain natriuretic peptide( NT-pro BNP),norepinephrine( NE) and epinephrine( E),plasma renin( PRA),angiotensin Ⅱ( Ang Ⅱ),aldosterone( ALD) were detected before operation and on the first postoperative day. After 6 months of follow-up,the incidence of heart failure of two groups were compared. Results There was no significant difference between the two groups in preoperative NT-pro BNP,NE,E,PRA,Ang Ⅱ and ALD levels( P >0. 05),the observation group had decreased NT-pro BNP,NE,E,PRA,Ang Ⅱ,ALD levels at 1 d after operation than operation before and the control group( P < 0. 05). At 1 month after surgery,the observation group had lower LVDEd,LVSEd,LAd,and higher LVEF than treatment before and control group( P < 0. 05). The incidence of heart failure after 6 months in the observation group and the control group was 1 1. 1 %,2 4. 4 % respectively,and the difference was statistically significant( χ2= 7. 31,P < 0. 05). Conclusion Percutaneous coronary intervention( PCI) timing can affect the prognosis of patients with myocardial infarction. Compared with elective PCI,emergency PCI can inhibit the RAAS system and sympathetic activation,improve ventricular remodeling and left ventricular function after myocardial infarction,and reduce the incidence of secondary heart failure.
引文
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[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[C].中华医学会心血管病学分会,2011.
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[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-118.
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[9]Park H S,Kim C J,Yi J E,et al.Contrast Volume/Raw e GFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction[J].Cardiorenal Med,2015,5(1):61-68.
[10]Victor D,Gerardo S,Gabriel P,et al.Does early coronary artery bypass surgery improve survivalin non-ST acute myocardial infarction[J].Interactive Cardio Vascular and Thoracic Surgery,2013,17(1):140-142.
[11]Reddy V S,Bui Q T,Jacobs J R,et al.Relationship Between Serum Low-Density Lipoprotein Cholesterol and In-hospital Mortality Following Acute Myocardial Infarction(The Lipid Paradox)[J].Am J Cardiol,2015,115(5):557-562.
[12]Wang J,Li N,Gao F,et al.Balance between angiotensin converting enzyme and angiotensin converting enzyme 2 in patients with chronic heart failure[J].J Renin-Angio-Aldo S,2015,16(3):553-558.
[13]赵勇,孟广军,笪伟,等.PCI对急性心肌梗死后心室重构及功能的影响[J].中华全科医学杂志,2012,10(5):690,738.
[14]冯巧丽,卢成志,李超,等.去肾交感神经术治疗犬心肌梗死的效果及机制探讨[J].山东医药,2017,15(57):43-44.
[15]池一凡,孙忠东,侯文明,等.急性心肌梗死介入治疗的临床效果与手术时机探讨[J].中国胸心血管外科临床杂志,2011,18(6):531-535.
[2]Shammas N W,Shammas G A,Jerin M,et al.Predictors of long-term survival of individuals with acute coronary syndrome aged 90 and older admitted to a tertiary care center[J].J Am Geriatr Soc,2015,63(11):2410-2412.
[3]胡晓峰,杨明,李贵森,等.冠脉介入术对急性心肌梗死患者血浆CRP、MMP-9及P选择素浓度的影响[J].宁夏医科大学学报,2015,37(5):591-593.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[C].中华医学会心血管病学分会,2011.
[5]任晖,黄立勋,庄贵华,等.急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析[J].心脏杂志,2014,26(6):662-665.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-118.
[7]陈颧珠.实用心脏病学[M].4版.上海:上海科学技术出版社,2007:871-888.
[8]罗继健,麦家志,王风.急性心肌梗死后心室重构的发生机理和治疗研究进展[J].广西医学,1999(21):244-251.
[9]Park H S,Kim C J,Yi J E,et al.Contrast Volume/Raw e GFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction[J].Cardiorenal Med,2015,5(1):61-68.
[10]Victor D,Gerardo S,Gabriel P,et al.Does early coronary artery bypass surgery improve survivalin non-ST acute myocardial infarction[J].Interactive Cardio Vascular and Thoracic Surgery,2013,17(1):140-142.
[11]Reddy V S,Bui Q T,Jacobs J R,et al.Relationship Between Serum Low-Density Lipoprotein Cholesterol and In-hospital Mortality Following Acute Myocardial Infarction(The Lipid Paradox)[J].Am J Cardiol,2015,115(5):557-562.
[12]Wang J,Li N,Gao F,et al.Balance between angiotensin converting enzyme and angiotensin converting enzyme 2 in patients with chronic heart failure[J].J Renin-Angio-Aldo S,2015,16(3):553-558.
[13]赵勇,孟广军,笪伟,等.PCI对急性心肌梗死后心室重构及功能的影响[J].中华全科医学杂志,2012,10(5):690,738.
[14]冯巧丽,卢成志,李超,等.去肾交感神经术治疗犬心肌梗死的效果及机制探讨[J].山东医药,2017,15(57):43-44.
[15]池一凡,孙忠东,侯文明,等.急性心肌梗死介入治疗的临床效果与手术时机探讨[J].中国胸心血管外科临床杂志,2011,18(6):531-535.