替罗非班联合PCI治疗对急性心肌梗死患者炎症因子和心功能的影响

目的:探讨替罗非班联合经皮冠状动脉介入(PCI)治疗对急性心肌梗死患者炎症因子和心功能的影响。方法:选取我院于2017年1~12月间收治的82例急性心肌梗死患者,按照随机数字表法分为两组,对照组41例予PCI治疗,研究组41例予替罗非班联合PCI治疗。比较两组患者临床疗效,IL-6、IL-17、IL-10、CRP等炎症因子水平,左心室舒张末期内径、左心室收缩末期内径、左心室射血分数等心功能相关指标以及不良心脏事件发生情况。结果:治疗后,研究组临床有效率(90.24%)显著高于对照组(78.05%),P0.05。两组患者干预前IL-6、IL-17、IL-10、CRP水平比较无显著性差异(P0.05),干预后两组IL-6、IL-17、CRP水平均显著降低,IL-10水平均显著升高,且研究组较对照组改变明显(P0.05)。两组患者干预前左心室舒张末期内径、左心室收缩末期内径、左心室射血分数比较无显著性差异(P0.05),干预后两组左心室舒张末期内径、左心室收缩末期内径均显著降低,左心室射血分数均显著升高,且研究组较对照组改善明显(P0.05)。研究组不良心脏事件发生率(4.88%)显著低于对照组(19.51%),P0.05。结论:急性心肌梗死患者采用替罗非班联合PCI治疗可显著改善心功能,降低炎症因子水平及不良心脏事件发生率,疗效确切。     

参麦注射液对心肌梗死患者内皮素及心室重构影响

目的:探讨参麦注射液对急性心肌梗死患者血清内皮素水平及心室重构的影响.方法:急性心肌梗死患者40例分为参麦治疗组及常规治疗组各20例,现察2组患者血中内皮素水平变化;应用心脏彩超测量2组左心室舒张末期内径、收缩及舒张末期容积、左室射血分数及短轴缩短率.并与同期健康体检正常者(对照组)进行对比分析.结果:治疗后4,7 d参麦治疗组血中内皮素水平与常规治疗组比较差异有统计学意义(P＜0.05);治疗后4周常规治疗组左心室舒张末期内径,收缩、舒张末期容积与本组治疗后1周及同期参麦治疗组比较,差异均有统计学意义(P＜0.05);参麦治疗组左室射血分数和短轴缩短率与本组治疗后1周及同期常规治疗组比较差异有统计学意义(P＜0.05).结论:参麦注射液可降低急性心肌梗死患者血中内皮素水平,抑制或减轻急性心肌梗死后心室重构的发生、发展,改善左心室功能及预后.     

参麦川芎嗪对心肌梗死后心力衰竭心室重构的影响

目的:探讨参麦合用川芎嗪注射液对急性心肌梗死后心力衰竭、心室重构的影响。方法:选择急性心肌梗死住院患者43例,分为应用参麦、川芎嗪注射液组(治疗组)及未用参麦、川芎嗪注射液组(对照组),观察两组心力衰竭发生率并通过心脏彩超检测两组心脏左室舒张末期内径、左室舒张末期容积、左室收缩末期容积、左室射血分数及左室短轴缩短率。结果:治疗后4周,治疗组左室射血分数和左室短轴缩短率与本组治疗后1周及同期对照组相比差异有统计学意义(P<0.05);对照组左室舒张末期容积、左室收缩末期容积与本组治疗后1周及同期治疗组比较差异有统计学意义(P<0.05);治疗组心力衰竭发生率比对照组明显降低(P<0.05)。结论:参麦、川芎嗪注射液联合应用能抑制或减轻急性心肌梗死后左室重构,降低心力衰竭发生率,从而改善预后。     

直接PCI治疗对高龄急性心肌梗死患者心室慢性重构的影响

目的探究直接PCI治疗对高龄急性心肌梗死患者心室慢性重构的影响。方法将我院收治的88例老年心肌梗死患者,随机分成观察组与对照组,每组44例。对照组实施常规药物治疗,观察组实施直接PCI治疗,随后对超声心动图进行随访,并比较两组治疗后BNP、CK、CK-MB及hs-CRP水平。结果从超声随访结果上来看,两组患者的室间隔厚度与左心室后壁厚度比较,无显著差异(P>0.05)。两组患者的室壁运动指数、球形指数、左心室短轴直径、左心室长轴直径、左心室射血分数、舒张末左心室容积、收缩末左心室容积、E峰减速时长、E/A和左心室舒张末内径比较,差异有统计学意义(P<0.05)。治疗后,观察组的CK-MB、CK、BNP与hs-CRP水平显著低于对照组(P<0.05)。结论对于高龄心肌梗死患者,使用直接PCI治疗能够全面改善患者心室重构现象,并降低病灶扩张率和心衰发生率,临床效果显著,值得进一步推广。     

实时三维超声心动图定量评价急性下壁心肌梗死患者左心室节段收缩功能

目的:探讨实时三维超声心动图评估急性下壁心肌梗死患者左心室节段收缩功能的可行性。方法:急性下壁心肌梗死患者20例(AMI组),同期选择年龄、性别相匹配的健康体检者20名为对照组,常规测量左心室舒张末内径(LVDD)、左心室下壁厚度(LVIW)及simpson双平面法测量左心室射血分数(LVEF)等指标。然后行实时三维超声心动图检查,测量2组左心室下壁节段舒张末期容积(r ESVIM)、左心室下壁节段收缩末期容积(r ESVIM)和左心室下壁节段射血分数(r EFIM)以及左心室射血分数(LVEF)、左心室整体收缩末期容积(LVGEDV)、左心室整体舒张末期容积(LVGESV)。结果:AIMI组LVGEDV、LVGESV高于对照组,LVGEF值低于对照组(P0.05);AIMI组r EDVIM、r ESVIM高于对照组,r EFIM值低于对照组(P0.0 5)。结论:实时三维超声心动图可准确评估急性下壁心肌梗死患者左心室几何形态、节段容积及节段收缩功能。     

经桡动脉行PCI对急性心肌梗死患者心功能及心室重构的影响分析

目的探究经桡动脉行经皮冠状动脉介入术(PCI)对急性心肌梗死患者心功能及心室重构的影响。方法选取2020年3月至2022年3月于本院行PCI的急性心肌梗死患者184例,依据随机数字表法分成对照组和观察组各92例。对照组行经股动脉入路行PCI,观察组行经桡动脉入路行PCI。比较两组手术相关指标、心功能、心室重构指标、术后并发症发生率。结果两组手术操作时间对比,差异无统计学意义(P>0.05);观察组血管穿刺时间长于对照组,术后卧床时间及术后住院时间均短于对照组,差异均有统计学意义(P<0.05)。术后3 d,两组左室射血分数(LVEF)均高于术前,且观察组较对照组更高,两组左心室收缩末期内径(LVESd)、左心室舒张末内径(LVEDd)均降低,且观察组较对照组更低,差异均有统计学意义(P<0.05);术后3 d,两组心室重构指标左室重构指数(LVRI)、左心室质量指数(LVMI)值均低于术前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组的术后并发症总发生率为4.35%,低于对照组的16.30%,差异有统计学意义(P<0.05)。结论相比于经股动脉入路,选择经桡动脉行PCI治疗急性心肌梗死能缩短患者术后恢复时间,促进患者心功能改善,对心室重构实施抑制,并术后并发症少,安全性更高,可于临床推广。     

支架术对老年急性心肌梗死患者近期左心室舒张功能的影响

目的 观察冠状动脉介入治疗(PCI术)对老年(年龄≥65岁)急性心肌梗死(AMI)患者近期(3个月)左心室舒张功能的影响.方法40例老年AMI患者随机分为PCI组和单纯药物治疗的非手术组,观察治疗3个月后左心室舒张功能各指标的变化,并与治疗前进行比较,确定PCI的治疗效果.主要观察指标:左心房前后径(LA-胸骨旁左心室长轴切面);左心室舒张末期内径(LV-胸骨旁左心室长轴切面);左心室射血分数(LVEF);左心室舒张功能指标:二尖瓣口舒张早期血流最大充盈速度(E)、舒张晚期血流最大充盈速度(A),计算E/A;肺静脉心室收缩S波、心室舒张D波,计算S/D.结果PCI组治疗后左心房室内径无明显增大,而非手术组左心房室内径明显增大(P<0.05);左心室舒张功能两组均进一步受损,但PCI组明显好于非手术组(P<0.05).结论PCI治疗可延缓老年AMI患者左心室重塑的进展及舒张功能的恶化.     

重组人脑利钠肽对急性前壁心肌梗死患者血清可溶性基质溶素-2的影响及预后

目的探讨重组人脑利钠肽(rhBNP)对急性前壁心肌梗死患者血清可溶性基质溶素-2(ST2)和预后的影响。方法将80例行急诊经皮冠状动脉介入手术(PCI)的急性前壁心肌梗死患者按照随机数字表法分为两组,对照组39例采用常规治疗方案,研究组41例在对照组基础上增加rhBNP治疗。对比两组患治疗前后血流动力学指标、心功能指标、血清可溶性ST-2、肌酸磷酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)以及预后的差异。结果与对照组相比,研究组患者PCI术后心率(HR)、呼吸(RR)、中心静脉压(CVP)明显下降(P<0.05),血氧饱和度(SaO2)明显升高(P<0.05);血清可溶性ST2、CK、CK-MB、cTnI水平明显下降(P<0.05);左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)明显下降(P<0.05),左心室射血分数(LVEF)明显升高(P<0.05)。研究组术后1年主要心脏不良事件(MACE)发生率低于对照组(19.51%比53.85%,P<0.05),两组1年生存率差异无统计学意义(92.61%比89.05%,P<0.05)。结论 rhBNP可稳定急性前壁心肌梗死患者血流动力学,降低血清可溶性ST2水平,延缓左室重构,降低MACE发生率,改善患者预后。     

实时三维超声心动图定量评价急性下壁心肌梗死患者左心室节段收缩功能的价值

目的探讨实时三维超声心动图评估急性下壁心肌梗死患者左心室节段收缩功能的应用价值。方法急性下壁心肌梗死患者20例为AMI组,同期健康体检者20名为对照组,均于常规测量左心室舒张末内径、左心室下壁厚度、左心室射血分数等指标后行实时三维超声心动图检查,测量2组左心室整体收缩末期容积(global end-systolicvolume,GESV)、左心室整体舒张末期容积(global end-diastolic volume,GEDV)、左心室整体射血分数(global ejectionfraction,GEF)、左心室下壁节段舒张末期容积(inferior wall regional end-diastolic volume,rEDVIW)、左心室下壁节段收缩末期容积(inferior wall regional end-systolic volume,rESVIW)和左心室下壁节段射血分数(inferior wall regionalejection fraction,rEFIW),并进行比较。结果 AIM组GEDV,GESV,rEDVIW,rESVIW高于对照组(P<0.05);GEF,rEFIW低于对照组(P<0.05)。结论实时三维超声心动图可准确评估急性下壁心肌梗死患者左心室几何形态、节段容积及节段收缩功能。     

尼可地尔联合替罗非班对急诊经皮冠状动脉介入术患者心肌灌注的临床价值

目的探讨冠状动脉内联合应用尼可地尔与替罗非班对急性心肌梗死急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)患者心肌灌注的临床疗效。方法选取宁夏医科大学总医院2017年10月至2018年12月诊治的急性心肌梗死急诊PCI患者134例,采用随机数字表法分为对照组与观察组各67例。对照组给予冠脉内替罗非班治疗,观察组给予冠状动脉内尼可地尔联合替罗非班治疗,于治疗前和术后12周行生化指标检测、心肌声学造影检查、心功能评定,比较两组患者心血管不良事件。结果观察组患者术后12周N-末端脑钠肽前体、肿瘤坏死因子α、高敏C反应蛋白、肌钙蛋白I、TIMI血流帧幅数、白细胞介素-6、肌酸激酶同工酶、造影剂开始灌注时间、灌注达到峰值时间、灌注峰值强度、振幅、曲线上升斜率、左心室舒张末期容积、左心室收缩末期容积、左心室舒张末期内径、左心室收缩末期内径低于对照组(P<0.05)。观察组患者术后12周TIMI血流分级、左心室射血分数、舒张早期与舒张末期二尖瓣血流速度比值高于对照组(P<0.05)。观察组患者心血管不良事件的总发生率低于对照组(P<0.05)。结论冠状动脉内联合应用尼可地尔与替罗非班可明显改善急性心肌梗死急诊PCI患者心肌灌注状况,可减轻炎症,并提高心功能。     

ST段抬高型心肌梗死患者循环微RNA-92a表达的研究

目的 了解微RNA-92a(miR-92a)在ST段抬高型心肌梗死(STEMI)发生发展中的表达,以及经皮冠状动脉介入治疗(PCI)对循环miR-92a表达的影响,探讨miR-92a在冠心病临床应用中的可能性.方法 82例STEMI患者及116例慢性稳定型心绞痛(SAP)患者按照是否接受PCI治疗分为STEMI行PCI治疗组(58例)、STEMI未行PCI治疗组(24例)及SAP未行PCI治疗组(116例)3组,分析比较其循环miR-92a表达的差异.结果 STEMI未行PCI患者入院次日循环miR-92a表达水平高于SAP未行PCI者(0.286 9±0.816 7比-0.055 5±0.985 5,P=0.121).PCI治疗24 h后STEMI行PCI患者循环miR-92a表达水平低于STEMI未行PCI者(-0.032 4±0.956 3比0.286 9±0.816 7,P=0.156).SAP未行PCI患者出院存活率显著高于STEMI未行PCI者(100.0％比75.0％,P=0.001),STEMI行PCI患者出院存活率高于STEMI未行PCI者(89.7％比75.0％,P=0.088).结论 STEMI患者循环miR-92a表达增高;PCI治疗能降低STEMI患者循环miR-92a表达;miR-92a表达下调的STEMI患者出院时存活率高于表达上调的STEMI患者.miR-92a很可能具有用于诊断或评估STEMI危险度、提高急性心肌梗死高危患者筛选的敏感性与准确性以及进行干预治疗的临床实际应用价值.     

The challenge of ST-segment elevation myocardial infarction

BACKGROUND/INTRODUCTION: Acute coronary syndromes (ACS) represent a spectrum of ischaemic myocardial events that share a similar pathophysiology. ST-segment elevation myocardial infarction (STEMI), the most severe form of ACS short of sudden cardiac death, is a significant public health problem with an estimated 500,000 STEMI events every year in the United States. TREATMENT/THERAPY: The mortality and morbidity associated with STEMI is significant. Early reperfusion therapy is the most important aspect of the treatment of STEMI. There are two main methods of reperfusion therapy: percutaneous coronary intervention (PCI) and fibrinolytic therapy, with PCI being the preferred method. In addition to standard reperfusion therapy, antithrombotics (unfractionated heparin and low molecular weight heparins) and antiplatelet agents (aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors) are critical adjuncts, effective in the treatment of acute STEMI. CONCLUSIONS: The survival of patients with STEMI depends on rapid diagnosis and optimal early treatment. Guidelines for the management of patients with STEMI recommend PCI within 90 min of presentation and that fibrinolytics are administered within 30 min. However, only a fraction of patients undergo reperfusion within the recommended time. Improvements in protocols for identifying STEMI cases are therefore required to allow reperfusion therapy to be initiated sooner. Secondary prevention is another important aspect of STEMI management, and patients should be encouraged to adopt strategies that reduce the risk of subsequent ischaemic events.     

Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI

BackgroundThe current ST-elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI) paradigm prevents some NSTEMI patients with acute coronary occlusion from receiving emergent reperfusion, in spite of their known increased mortality compared with NSTEMI without occlusion. We have proposed a new paradigm known as occlusion MI vs. nonocclusion MI (OMI vs. NOMI).ObjectiveWe aimed to compare the two paradigms within a single population. We hypothesized that STEMI(–) OMI would have characteristics similar to STEMI(+) OMI but longer time to catheterization.MethodsWe performed a retrospective review of a prospectively collected acute coronary syndrome population. OMI was defined as an acute culprit and either TIMI 0–2 flow or TIMI 3 flow plus peak troponin T > 1.0 ng/mL. We collected electrocardiograms, demographic characteristics, laboratory results, angiographic data, and outcomes.ResultsAmong 467 patients, there were 108 OMIs, with only 60% (67 of 108) meeting STEMI criteria. Median peak troponin T for the STEMI(+) OMI, STEMI(–) OMI, and no occlusion groups were 3.78 (interquartile range [IQR] 2.18–7.63), 1.87 (IQR 1.12–5.48), and 0.00 (IQR 0.00–0.08). Median time from arrival to catheterization was 41 min (IQR 23–86 min) for STEMI(+) OMI compared with 437 min (IQR 85–1590 min) for STEMI(–) OMI (p < 0.001). STEMI(+) OMI was more likely than STEMI(–) OMI to undergo catheterization within 90 min (76% vs. 28%; p < 0.001).ConclusionsSTEMI(–) OMI patients had significant delays to catheterization but adverse outcomes more similar to STEMI(+) OMI than those with no occlusion. These data support the OMI/NOMI paradigm and the importance of further research into emergent reperfusion for STEMI(–) OMI.     

The use of a 4-step algorithm in the electrocardiographic diagnosis of ST-segment elevation myocardial infarction by novice interpreters

The electrocardiographic (ECG) diagnosis of ST-segment elevation myocardial infarction (STEMI) represents a challenge to all health care providers, particularly so for the novice ECG interpreter. We have developed—and present in this article—a 4-step algorithm that will detect STEMI in most instances in the prehospital and other nonemergency department (ED) settings. The algorithm should be used in adult patients with chest pain or equivalent presentation who are suspected of STEMI. It inquires as to the presence of ST-segment elevation as well as the presence of STEMI confounding/mimicking patterns; the algorithm also makes use of reciprocal ST-segment depression as an adjunct in the ECG diagnosis of STEMI. If STEMI is detected by this algorithm, then management decisions can be made based upon this ECG diagnosis. If STEMI is not detected using this algorithm, then we can only note that STEMI is not “ruled in”; importantly, STEMI is not “ruled out.” In fact, more expert interpretation of the ECG will be possible once the patient (and/or the ECG) arrive in the ED where ECG review can be made with the more complex interpretation used by expert physician interpreters.     

Prehospital Nitroglycerin Safety in Inferior ST Elevation Myocardial Infarction

Patients with inferior ST elevation myocardial infarction (STEMI), associated with right ventricular infarction, are thought to be at higher risk of developing hypotension when administered nitroglycerin (NTG). However, current basic life support (BLS) protocols do not differentiate location of STEMI prior to NTG administration. We sought to determine if NTG administration is more likely to be associated with hypotension (systolic blood pressure < 90 mmHg) in inferior STEMI compared to non-inferior STEMI. We conducted a retrospective chart review of prehospital patients with chest pain of suspected cardiac origin and computer-interpreted prehospital ECGs indicating “ACUTE MI.” We included all local STEMI cases identified as part of our STEMI registry. Univariate analysis was used to compare differences in proportions of hypotension and drop in systolic blood pressure ≥ 30 mmHg after nitroglycerin administration between patients with inferior wall STEMI and those with STEMI in another region (non-inferior). Multiple variable logistic regression analysis was also used to assess the study outcomes while controlling for various factors. Over a 29-month period, we identified 1,466 STEMI cases. Of those, 821 (56.0%) received NTG. We excluded 16 cases because of missing data. Hypotension occurred post NTG in 38/466 inferior STEMIs and 30/339 non-inferior STEMIs, 8.2% vs. 8.9%, p = 0.73. A drop in systolic blood pressure ≥ 30 mmHg post NTG occurred in 23.4% of inferior STEMIs and 23.9% of non-inferior STEMIs, p = 0.87. Interrater agreement for chart review of the primary outcome was excellent (κ = 0.94). NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories. Computer interpretation of inferior STEMI cannot be used as the sole predictor for patients who may be at higher risk for hypotension following NTG administration.     

Differences in biomarker concentrations and predictions of long-term outcome in patients with ST-elevation and non-ST-elevation myocardial infarction

BackgroundDifferences in biomarkers reflective of pathobiology and prognosis between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are incompletely understood and may offer insights for tailoring of treatment.MethodsThis registry-based study included 538 STEMI and 544 NSTEMI patients admitted 2008–2014. Blood samples were collected day 1–3 after admission and 175 biomarkers were analyzed using Proximity Extension Assay and Multiple Reaction Monitoring mass spectrometry. Adjusted Lasso analysis (penalized logistic regression model) was used to select biomarkers that discriminated STEMI from NSTEMI patients. Biomarkers identified by the Lasso analysis were then evaluated in adjusted Cox regressions for associations with death or major adverse cardiovascular events.ResultsBiomarkers strongly discriminated STEMI and NSTEMI when considered simultaneously in adjusted Lasso analysis (c-statistic 0.764). Eleven biomarkers independently discriminated STEMI and NSTEMI; seven showing higher concentrations in STEMI: myoglobin, N-terminal pro-B-type natriuretic peptide, serum amyloid A-1 and A-2 protein, ST2 protein, interleukin-6 and chitinase-3-like protein 1; and four showing higher concentrations in NSTEMI: fibroblast growth factor 23, membrane-bound aminopeptidase P, tumor necrosis factor-related activation-induced cytokine and apolipoprotein C-I. During up to 6.6 years of prognostic follow-up, none of these biomarkers exhibited different associations with adverse outcome between STEMI and NSTEMI.ConclusionsIn the acute setting, biomarkers indicated greater myocardial dysfunction and inflammation in STEMI, whereas they displayed a more diverse pathophysiologic pattern in NSTEMI patients. These biomarkers were similarly prognostic in STEMI and NSTEMI patients. The results do not support treating STEMI and NSTEMI patients differently based on the concentrations of these biomarkers.     

Detection of STEMI Using Prehospital Serial 12-Lead Electrocardiograms

Objective: Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction. Methods: We performed a retrospective study of suspected STEMI patients transported by EMS in the Chaudière-Appalaches region (Québec, Canada) between August 2006 and December 2013. Patients were monitored by a serial 12-lead ECG system where an averaged ECG was transmitted every 2 minutes. Following review by an emergency physician, ECGs were grouped as having either a persistent STE or a dynamic STE that evolved over time. Results: A total of 754 suspected STEMI patients were transported by EMS during the study period. Of these, 728 patients met eligibility criteria and were included in the analysis. A persistent STE was observed in 84.3% (614/728) of patients, while the remaining 15.7% (114/728) had a dynamic STE. Among those with dynamic STE, 11.1% (81/728) had 1 ST-segment change (41 no-STEMI to STEMI; 40 STEMI to no-STEMI) and 4.5% (33/728) had ≥ 2 ST-segment changes (17 no-STEMI to STEMI; 16 STEMI to no-STEMI). Overall, in 8.0% (58/728) of the cohort, STEMI was identified on a subsequent ECG following an initial no-STEMI ECG. Conclusions: Through recognition of transient ST-segment changes during transport via the prehospital serial 12-lead ECG system, STEMI was identified in 8% of suspected STEMI patients who had an initial no-STEMI ECG.     

ST段抬高型心肌梗死患者纤维蛋白原和D-二聚体的变化

目的 探讨ST段抬高型心肌梗死(STEMI)患者与冠状动脉造影阴性者纤维蛋白原和D-二聚体含量的差异.方法 选取我院2005年1月至2007年12月诊断为STEMI并行直接经皮冠状动脉介入(PCI)治疗的患者100例.同时选取冠状动脉造影阴性者100例为对照组.比较2组间纤维蛋白原和D-二聚体含量.结果 2组性别、年龄、高血压史、糖尿病史和吸烟史差异无统计学意义(P均0.05).STEMI组血浆纤维蛋白原含量为(2.38±0.91)g/L,对照组为(2.65±0.68)g/L,差异有统计学意义(t=-2.34,P<0.05).D-二聚体的平方根STEMI组为(13.23±5.08)μg/L,对照组为(9.40±5.03)μg/L,差异有统计学意义(t=5.36,P<0.01).血浆D-二聚体与纤维蛋白原含量比值的平方根STEMI组为(9.11±4.13),对照组为(5.92±3.35),差异有统计学意义(t=5.99,P<0.01).结论 STEMI患者的纤维蛋白原低于冠状动脉造影阴性的对照组,D-二聚体高于对照组,提示在STEMI急性期存在急性血栓形成和继发纤溶.     

规范化急救护理路径在ST段抬高性心肌梗死患者中的应用

目的:探讨规范化急救护理路径在抢救STEMI患者中的可行性效果,并建立完善的STEMI急救护理路径。方法:制定STEMI急救护理路径,对93例患者(实验组)按路径实施急救护理,并与实施传统护理流程的77例患者(观察组)进行比较。结果:实验组进-出急诊时间,就诊-首次球囊扩张时间（DTB时间）,院内心肌梗死复发率,再次PCI率均显著少于观察组。(P<0.05)结论:急救护理路径应用于STEMI患者,可为患者赢得有效的抢救时机,提高救治率。     

Implementation of Specialty Centers for Patients with ST-Segment Elevation Myocardial Infarction

Background. Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy andis associated with reduced morbidity andmortality for patients with ST-segment elevation myocardial infarction (STEMI). Objective. To determine the performance of a regional system with prehospital 12-lead electrocardiogram (ECG) identification of STEMI patients anddirect paramedic transport to STEMI receiving centers (SRCs) for provision of primary PCI. Methods. This was a prospective study evaluating the first year of implementation of a regional SRC network to determine the key time intervals for patients identified with STEMI in the prehospital setting. Results. During the 12-month study period, 1,220 patients with a suspected STEMI were identified on prehospital 12-lead ECG, of whom 734 (60%) underwent emergency PCI. A door-to-balloon time of 90 minutes or less was achieved for 651 (89%) patients, and459 (62.5%) had EMS–patient contact-to-balloon times ≤ 90 minutes. Transport of suspected STEMI patients to an SRC resulted in ambulance diversion from a closer ED for 31% of patients anda median increase in transport time of 3.8 minutes. Conclusion. Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system