PCI治療STEMI發(fā)生再灌注損傷的危險因素分析

張欣 李小玲

[關(guān)鍵詞] 急性ST段抬高型心肌梗死;PCI;心肌缺血后再灌注損傷;危險因素

[中圖分類號] R542.22? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-9701（2021）25-0010-03

Analysis of risk factors of reperfusion injury of STEMI treated by PCI

ZHANG Xin? ?LI Xiaoling

Department of Cardiology， Tongde Hospital of Zhejiang Province， Hangzhou? ?310012， China

[Abstract] Objective To explore the risk factors of reperfusion injury of STEMI treated by PCI. Methods The clinical data of 162 STEMI patients who underwent PCI treatment in our hospital from January 2018 to June 2020 were retrospectively analyzed. The patient′s general information and clinical data were recorded，including patient gender， age， smoking history， BMI， history of hypertension， history of diabetes， history of stroke， family history of cardiovascular disease， time from onset to treatment， blood vessels of the offender， blood pressure， BUN， Scr， BNP， CK， CK-MB， TC， TG，? LDL-C， and HDL-C at admission， the FBG， cTnI， cTnT the next day after surgery.Single factor and multiple factors were used to analyze the influencing factors of reperfusion injury in STEMI treated by PCI. Results ①Univariate analysis showed that the culprit′s vessel was the right coronary artery， and the incidence of IRI was higher in patients with systolic blood pressure <140 mmHg at admission（P<0.05）， the levels of BNP， CK， CK-MB， cTnI， cTnT in the IRI group were higher， and the difference was statistically significant（P<0.05）.②The results of multivariate analysis showed that the culprit′s blood vessel being the right coronary artery and the systolic blood pressure<140 mmHg on admission， BNP， CK， CK-MB， cTnI， and cTnT levels were independent risk factors for reperfusion injury in STEMI treated with PCI（OR=6.129， 3.532， 3.811， 4.104， 3.967， 4.627， 4.380， P<0.05）. Conclusion The risk factors for reperfusion injury in STEMI treated by PCI include the culprit′s blood vessel being the right coronary artery， decreased systolic blood pressure at admission， and levels of BNP， CK， CK-MB， cTnI， and cTnT.This study indicates that the severity of the patient′s disease is closely related to reperfusion injury.

[Key words] Acute ST-segment elevation myocardial infarction; PCI; Reperfusion injury after myocardial ischemia; Risk factors

急性心肌梗死仍然是嚴重威脅生命的疾病之一。ST段抬高型心肌梗死（ST segment elevation myocardial infarction，STEMI）是指具有典型的缺血性胸痛、持續(xù)超過20 min、血清心肌壞死標記物濃度升高并有動態(tài)演變、心電圖具有典型的ST段抬高的一類急性心肌梗死。經(jīng)皮冠狀動脈介入治療（Percutaneous coronary intervention，PCI）是指經(jīng)心導(dǎo)管技術(shù)疏通狹窄甚至閉塞的冠狀動脈管腔，改善心肌血流灌注的治療方法，是目前臨床上救治急性心肌梗死的有效方法之一[1-2]。再灌注損傷是指缺血的組織在恢復(fù)血液灌注后導(dǎo)致再灌注區(qū)細胞及局部血管網(wǎng)出現(xiàn)病理生理變化，導(dǎo)致組織進一步損傷。PCI后發(fā)生心肌缺血后再灌注損傷（Ischemi-reperfusion injury，IRI）降低再灌注的治療效果，影響患者預(yù)后[3-4]。目前認為冠狀動脈狹窄率、再灌注前低血壓等與患者發(fā)生再灌注損傷有關(guān)[5]。本研究通過回顧性分析STEMI行PCI治療患者的臨床資料，分析發(fā)生再灌注損傷的影響因素，以期為臨床預(yù)防提供參考，現(xiàn)報道如下。