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目的评价STEMI患者急诊PCI术前脐周注射低分子肝素对心肌再灌注的影响,为今后挽救STEMI患者濒死心肌提供科学依据。方法对我院2008年1月～2009年8月110例行急诊PCI术的STEMI患者进行回顾性分析,比较术前脐周注射低分子肝素及PCI者与直接PCI者的PCI术中TIMI3级血流情况、无复流现象的发生情况、CK-MB酶峰值时间、术后半小时ST段回落>50%的情况及术后1月LVEF等再灌注指标。结果试验组的TIMI3级血流者发生率为85.7%,对照组69.1%;试验组的无复流现象发生率为0,对照组10.3%;试验组的CK-MB酶峰值时间的均数为12.03h,对照组为13.61h;试验组术后半小时ST段回落>50%的发生率为90.5%,对照组为75%;试验组的1月后EF>50%的发生率为95.0%,对照组为66.7%。差异有统计学意义(P<0.05)。结论 PCI术前脐周注射低分子肝素的STEMI患者的术中TIMI3级血流情况、无复流现象的发生情况、酶峰值时间、术后半小时ST段回落>50%情况及术后1月LVEF>50%的情况优于直接PCI者。STEMI患者行急诊PCI术前脐周注射低分子肝素可有效提高STEMI患者的再灌注水平,有效改善心肌缺血。
Objective To evaluate the effect of low molecular weight heparin injected into the STEMI patients during emergency PCI on myocardial reperfusion and to provide a scientific basis for the rescue of dying myocardium in STEMI patients. Methods A retrospective analysis was performed on 110 STEMI patients undergoing emergency PCI between January 2008 and August 2009 in our hospital. TIMI grade 3 blood was collected from patients undergoing perioperative umbilical cord injection of low molecular weight heparin and PCI and those undergoing PCI. Flow conditions, the occurrence of no-reflow phenomenon, CK-MB enzyme peak time, ST-segment depression after half an hour> 50% of the situation and 1 month after LVEF and other indicators of reperfusion. Results The incidence of TIMI grade 3 blood flow was 85.7% in the test group and 69.1% in the control group. The incidence of no-reflow phenomenon in the test group was 0 and that in the control group was 10.3%. The mean peak time of CK-MBase in the test group was 12.03h in the control group and 13.61h in the control group. The incidence of> 50% ST-segment depression in the experimental group was 90.5% in half an hour and 75% in the control group. The incidence of EF> 50% in the experimental group after one month was 95.0% Compared with 66.7% in the control group. The difference was statistically significant (P <0.05). Conclusions TIMI grade 3 blood flow, no-reflow phenomenon, peak enzyme duration, ST-segment depression> 50% at half an hour after PCI, and postoperative 1 month after STEMI with low molecular weight heparin injected before PCI LVEF> 50% is better than direct PCI. Uterine injection of low molecular weight heparin before emergency PCI in STEMI patients can effectively improve the reperfusion level in STEMI patients and effectively improve myocardial ischemia.