【摘要】 目的观察不同时间血运重建对老年急性心肌梗死患者心功能及不良心脏事件的影响。方法选择2017年4月—2019年4月清华大学附属垂杨柳医院老年病科诊治急性心肌梗死患者116例作为研究对象,按血运重建时间分为对照组(n=58)和观察组(n=58)。对照组进行择期血运重建,观察组采用急诊血运重建,对治疗效果进行评估,比较2组治疗1周、3个月、6个月后心功能水平,运动速度峰值变化、血清Ⅰ型前胶原羧基端肽(PICP)、Ⅲ型前胶原(PCⅢ)水平及其比值变化,以及心脏不良事件的发生率。结果治疗后1周,2组LVEF、LVEDD、LVESD比较,差异无统计学意义(P>0.05),治疗后3个月时,观察组LVEF增加明显(P<0.05);于同时间点2组心功能比较差异有统计学意义(P<0.05);观察组治疗后1周、3个月、6个月Sa水平高于对照组(F/P=8.491/0.000),2组治疗后3个月及6个月Sa水平高于治疗后1周(P<0.01);观察组治疗后1周、3个月及6个月血清PICP、PCⅢ水平低于对照组(F/P=9.437/0.000,6.326/0.000)。观察组不良心脏事件总发生率低于对照组(χ~2/P=6.892/0.010)。结论急诊血运重建能够显著抑制老年急性心肌梗死心脏胶原重构,改善患者心功能水平,降低心脏不良事件的发生率,显著改善预后。更多还原

【Abstract】 Objective To observe the effect of revascularization at different time on cardiac function and adverse cardiac events in elderly patients with acute myocardial infarction.Methods From April 2017 to April 2019, 116 patients with acute myocardial infarction(AMI) were selected from the Department of Geriatrics, Chuiyangliu Hospital Affiliated to Tsinghua University as the study object, and randomly divided into control group(n=58) and observation group(n=58). The control group underwent selective revascularization, the observation group adopted emergency revascularization to evaluate the therapeutic effect, compared the cardiac function level of the two groups, the peak change of exercise speed after 1 week, 3 months and 6 months of treatment, the change of serum level and ratio of type I procollagen carboxyl terminal peptide(PICP), type Ⅲ procollagen(PC Ⅲ), and the incidence of adverse cardiac events.Results 1 week after treatment, there was no significant difference in LVEF, LVEDD and LVESD between the two groups(P>0.05); after treatment, LVEF increased significantly in the observation group(P<0.05); at the same time point, there was a significant difference in heart function between the two groups(P<0.05); the SA level of the observation group was higher than that of the control group(F/P=8.491/0.000); the SA level of the two groups was higher in the three and six months after treatment The level of serum PICP and PC Ⅲ in the observation group was lower than that in the control group(F/P=9.437/0.000, 6.326/0.000) at 1 week, 3 months and 6 months after treatment, and the level of serum PICP and PC Ⅲ in the observation group was higher than that in the control group at 3 and 6 months after treatment(P<0.05). The total incidence of adverse cardiac events in the observation group was lower than that in the control group(χ~2/P=6.892/0.010).Conclusion Emergency revascularization can significantly inhibit collagen remodeling, improve the level of cardiac function, reduce the incidence of adverse cardiac events, and significantly improve the prognosis.更多还原