内科

目的探讨急性ST段抬高型心肌梗死患者经皮冠状动脉球囊扩张术给予抗血栓治疗1周后再植入冠脉支架治疗的效果。方法回顾性分析2018年1月至2019年1月在我院接受经皮冠状动脉球囊扩张术治疗的97例急性ST段抬高型心肌梗死患者的临床资料，根据术后植入冠脉支架的时间，将患者分为即刻组（经皮冠状动脉球囊扩张术开通血管后即刻植入支架，51例）和延迟组（经皮冠状动脉球囊扩张术开通血管抗血栓治疗1周后再植入支架，46例）。比较两组患者的疗效、支架植入情况；比较两组患者治疗前和出院后10个月的血流动力学变化情况以及不良心血管事件发生情况。结果延迟组植入支架术后1 h内心电图ST段回落较术前≥50%、TIMI血流分级3级、心肌呈色3级患者的比例均显著高于即刻组，差异有统计学意义（P＜0.05）；延迟组患者植入的支架长度短于即刻组、数量少于即刻组，差异有统计学意义（P＜0.05）。出院后10个月，延迟组患者的平均动脉压（MAP）、心率（HR）均高于即刻组，不良心血管事件发生率（2.17%）显著低于即刻组（17.65%），差异有统计学意义（P＜0.05）。结论经皮冠状动脉球囊扩张术开通血管、抗血栓治疗1周后再植入冠脉支架治疗，可更有效地改善急性ST段抬高型心肌梗死患者的血流动力学指标，减少心血管事件的发生。

ObjectiveTo explore the therapeutic effect of patients with acute ST-segment elevation myocardial infarction after one-week antithrombotic therapy then undergoing the coronary stent implantation after percutaneous transluminal coronary balloon angioplasty. MethodsThe clinical data of 97 patients with acute ST-segment elevation myocardial infarction who underwent percutaneous transluminal coronary balloon angioplasty in our hospital from January 2018 to January 2019 were retrospectively analyzed. According to the timings of postoperative coronary stent implantation, patients were divided into immediate group (immediate stent implantation after recanalizing vessel by percutaneous transluminal coronary balloon angioplasty, 51 cases) and delayed group (after one-week antithrombotic therapy then with stent implantation after recanalizing vessel by percutaneous transluminal coronary balloon angioplasty, 46 cases). The efficacy and conditions of stent implantation were compared between the two groups. The hemodynamic changes and adverse cardiovascular events before treatment and 10 months after discharge were compared between the two groups. ResultsCompared with the immediate group, patients in the delayed group obtained higher proportions in postoperative ST-segment resolution within an hour after stent implantation ≥50%, in TIMI blood flow classification in grade 3, and in myocardial blush grade in grade 3, whereas a shorter length of implanted stent, and less number of the implanted stents, with statistically significant differences (P＜0.05). Ten months after discharge, the mean arterial pressure (MAP) and heart rate (HR) of the delayed group were higher than those of the immediate group, and the incidence of adverse cardiovascular events (2.17%) was significantly lower than that of the immediate group (17.65%), and the difference was statistically significant (P＜0.05). ConclusionPercutaneous transluminal coronary balloon angioplasty to recanalize blood vessels, and to conduct one-week antithrombotic therapy then with coronary stent implantation can more effectively improve the hemodynamic indicators of patients with acute ST-segment elevation myocardial infarction, and reduce the occurrence of cardiovascular events.