【摘要】 目的:研究对比急性心肌梗死(AMI)冠脉造影血管开通后即刻支架与延迟支架的效果及对预后的影响。方法:纳入AMI患者82例进行研究。将其按照信封法随机等分成延迟组和即刻组。两组均通过经皮冠状动脉介入术(PCI)或(和)血栓抽吸开通血管,即刻组血管开通后即刻置入支架,延迟组则未立即植入支架,而是在7～14 d复查冠脉造影后,按照病变血管狭窄程度决定是否置入支架。比较两组术后心肌灌注情况,PCI情况,术后主要不良心血管事件(MACE)发生情况,治疗后左心功能指标变化情况,治疗前后血清甲状腺球蛋白(TG)、甲状腺球蛋白抗体(TGAb)水平。结果:延迟组术后TIMI3级血流、MBG≥2级人数占比相较于即刻组均显著更高,而无复流人数占比相较于即刻组明显更低(P均<0.05)。延迟组支架直径相较于即刻组明显更大,而支架长度相较于即刻组明显更短(P均<0.05)。延迟组术后院内及术后6个月MACE发生率相较于即刻组均显著更低(P均<0.05)。术后6个月延迟组左室射血分数(LVEF)显著高于即刻组,而左心室舒张末期内径(LVEDD)显著低于即刻组(P均<0.05)。治疗后延迟组血清TG、TGAb水平相较于即刻组均明显较低(P均<0.05)。结论:AMI冠脉造影血管开通后延迟支架相较于即刻支架的效果更佳,有利于改善患者心肌灌注状况,促进心功能的恢复,且有效改善患者的甲状腺功能,预后效果更为理想。更多还原

【Abstract】 Objective:To compare the effect of immediate stent and delayed stent in acute myoardial infarction(AMI) after coronary angiography,and to analyze the effect on prognosis. Methods:82 patients with AMI were included in the study,and randomly divided into delayed group and immediate group according to envelope method. Both groups underwent percutaneous coronary intervention(PCI) or(and) thrombus aspiration and revascularization. In the immediate group,the stent was placed immediately after revascularization. In the delayed group,the stent was not implanted immediately,but the decision was made whether to place the stent according to the degree of stenosis of the diseased blood vessels after the coronary angiography on 7 to 14 days after revascularization. The postoperative myocardial perfusion,PCI,postoperative major adverse cardiovascular events(MACE),changes in left ventricular function indexes after treatment,the levels of serum thyroglobulin(TG) and thyroglobulin antibody(TGAb) before and after treatment were compared between the two groups. Results:The proportion of TIMI3 blood flow and MBG≥2 patients in the delayed group was significantly higher than that in the immediate group,while the proportion of non-reflow patients was significantly lower than that in the immediate group(all P<0.05). The diameter of the sent in the delayed group was significantly larger than that in the immediate group,while the length of the stent in the delayed group was significantly shorter than that in the immediate group(all P<0.05). The incidence of MACE in the delayed group in the hospital and 6 months after operation was significantly lower than that in the immediate group(all P<0.05). The left ventricular ejection fraction(LVEF) was significantly higher in the delayed group 6 months after operation than that in the immediate group,while the left ventricular end-diastolic diameter(LVEDD) was significantly lower than that in the immediate group(all P<0.05). After treatment,serum TG andTGAb levels in the delayed group were significantly lower than those in the immediate group(all P<0.05). Conclusion:After AMI coronary angiography,the delayed stent is more effective than the immediate stent,which is conducive to improve the myocardial perfusion status,promote the recovery of cardiac function,and effectively improve the thyroid function of patients,with better prognosis.更多还原