新疆医科大学学报

目的 探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)急诊经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术中应用高压球囊后扩张对患者无复流或慢血流发生影响。方法 选取新疆医科大学第一附属医院2018年8月-2020年8月收治的STEMI行急诊冠状动脉支架置入术患者242例,采用随机数字法将其分为试验组与对照组,各121例。试验组术中给予高压球囊后扩张,对照组不予后扩张。测定两组PCI术前后冠状动脉校正TIMI帧数(CTFC)、超敏C反应蛋白。记录两组患者支架内残余狭窄、无复流或慢血流、支架再狭窄、血栓复发等发生情况。记录两组患者术后1年主要心脏不良事件(MACE)发生率。比较两组支架置入理想达标率。结果 高压球囊后扩张后,试验组CTFC显著低于PCI术后即刻,且试验组CTFC显著低于对照组,差异均有统计学意义(P<0.05)。术后3 d,两组超敏C反应蛋白均显著低于PCI术后即刻,且试验组超敏C反应蛋白显著低于对照组,差异均有统计学意义(P<0.05)。试验组残余狭窄程度、胸痛始至血管再通时间均显著低于对照组,试验组手术时间显著长于对照组,差异均有统计学意义(P<0.05)。两组支架直径、支架长度、血栓抽吸、应用硝酸甘油、TIMI血栓分级(TTG)≥4级指标比较,差异均无统计学意义(P>0.05)。试验组无复流或慢血流发生率显著低于对照组,差异有统计学意义(P<0.05)。试验组MACE发生率显著低于对照组,差异均有统计学意义(P<0.05)。试验组支架置入理想达标率显著高于对照组,差异有统计学意义(P<0.05)。结论 STEMI急诊PCI术中应用高压球囊后扩张,能够明显减少心脏不良事件与支架内血栓发生风险,降低无复流或慢血流发生率,值得在临床推广。

Objective To investigate the effects of high-pressure balloon dilation during emergency PCI for acute STsegment elevation myocardial infarction on occurrence of no-reflow or slow blood flow in patients. Methods The study subjects selected 242 patients with acute ST-segment elevation myocardial infarction who underwent emergency coronary stent implantation who were admitted to the hospital from August 2018 to August 2020. The patients were divided into the experimental group and the control group by random number method, 121 cases each. The experimental group was given a high-pressure balloon during the operation for expansion, while the control group was not given a post-dilation. The number of coronary artery corrected TIMI frames(CTFC) and high sensitivity C-reactive protein before and after PCI were measured. The occurrence of residual stenosis in the stent, no reflow or slow blood flow,restenosis of the stent, and recurrence of thrombus were recorded in the two groups of the patients. The incidence of major adverse cardiac events(MACE) in the two groups were recorded at 1 year after the procedure. Compare the ideal rate of stent placement between the two groups. Results After the high-pressure balloon was inflated, the CTFC of the experimental group was significantly lower than that immediately after PCI; and the CTFC of the experimental group was significantly lower than that of the control group, and the differences were statistically significant(P<0. 05). At 3 days after the procedure, the two groups of hypersensitive C-reactive protein were significantly lower than those immediately after PCI, and the test group was significantly lower than the control group, the differences were statistically significant(P<0. 05). The degree of residual stenosis and the time from chest pain to recanalization of the experimental group were significantly lower than those of the control group. The operation time of the experimental group was significantly longer than that of the control group, and the difference was statistically significant(P<0. 05). There was no significant difference between the two groups of stent diameter, stent length, thrombus aspiration, application of nitroglycerin, TIMI thrombosis classification(TTG) ≥ grade 4 and other indicators(P>0. 05). The incidence of no-reflow or slow reflux in the test group was significantly lower than that in the control group, and the difference was statistically significant(P<0. 05). The incidence of MACE in the experimental group was significantly lower than that in the control group, and the differences were statistically significant(P<0. 05).The ideal rate of stent placement in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0. 05). Conclusion The application of high-pressure balloon expansion during PCI in acute ST-segment elevation myocardial infarction can significantly reduce the risk of adverse cardiac events and stent thrombosis, and it can reduce the incidence of no-reflow or slow blood flow, which is worthy of clinical promotion.