急诊经皮冠状动脉介入术中脉搏血氧饱和度监测的临床意义

 目的 观察急诊经皮冠状动脉介入治疗(percutaneous transluminal coronary intervention， PCI)中脉搏血氧饱和度水平与急性心肌梗死(acute myocardial infarction，AMI)患者临床疗效和预后的关系。方法 选择进行急诊PCI的AMI患者132例，术中持续监测脉搏血氧饱和度(SpO₂)，依据术中SpO₂水平将患者分为观察组(SpO₂＜90%，n=64)和对照组(SpO₂≥90%，n=68)。所有患者均行急诊PCI治疗。观察两组患者冠状动脉血管病变支数，术后四周两组间的左室收缩末期容积(LVESV)、舒张末期容积(LVEDV)和左室射血分数(LVEF);两组患者住院期间、术后6个月内的主要心脏不良事件和6个月时的6分钟步行试验(six-minute walk test，6MWT)。结果 观察组冠状动脉病变支数较对照组多(1.9±0.9)vs(1.2±0.8)，P<0.05)]，前降支为梗死相关血管的比例多于对照组(62.6% vs 41.2%，P<0.05);术后4周观察组的LVESV、LVEDV较对照组高，LVEF较对照组低，差异有统计学意义。观察组6个月时的6 MWT距离较对照组短，且住院期间、术后6个月的主要不良心脏事件发生率较对照组高，差异有统计学意义。结论 急诊PCI术中脉搏血氧饱和度水平是评价AMI患者临床疗效和预后的一种可靠指标。

Significance of monitoring pulse oxygen saturation during primary percutaneous coronary intervention with ST-segment elevation myocardial infarction

Objective To study the relationship between pulse oxygen saturation (SpO₂) during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and its clinical efficacy and prognostic value. Methods We studied 132 STEMI patients for whom pulse oxygen saturation was monitored continuously during primary PCI. According to the pS02, the patients were divided into the observation group(n=64, SpO₂＜90%) and the control group (n=68, SpO₂≥90%). We observed the number of the stenotic vessls, left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume(LVEDV)and Left ventricular ejection fraction (LVEF) 4 weeks after PCI, and also analyzed the major adverse cardiac events(MACE) and six-minute walk test between the hospitalization period and 6 months after PCI. Results The number of the stenotic vessls in the observation group was greater than in the observation group(1.9±0.9) vs (1.2±0.8), P<0.05], and the percentage of infarct-related artery in the left anterior descending artery was also higher (62.6% vs 41.2%, P<0.05). The diameters of LVESV, LVEDV were larger, and the LVEF was lower than the control group. The incidence of MACE between the hospitalization period and 6 months after PCI in the observation group was higher, while shorter in the six-minute walk test than the control group. Conclusions The pSO₂ during primary PCI with STEMI is a reliable index in evaluating the clinical efficacy and prognostic value.