AMI 患者行急诊与择期PCI 的术后心功能比较

目的 比较急性前壁心肌梗死患者6 ～ 12 h 行急诊经皮冠状动脉介入治疗（PCI）与择期PCI的术后心功能情况。方法 患者均在入院当天行心脏彩超检查，并于入院当日及每隔1 天监测血浆氨基末端B 型利钠肽前体（NT-proBNP）、肌钙蛋白Ⅰ（CTNI）。10 d 后再次行上述检查并进行分析。结果 急诊组出入院左心室舒张末内径（LVEDd）比较无差异（P >0.05），而左心室射血分数（LVEF）出院较入院下降（P <0.05）；择期组LVEDd 出院较入院增大（P <0.05），LVEF 出院较入院下降（P <0.05）。两组出入院LVEDd、LVEF 的差值比较有差异（P <0.05）。急诊组NT-proBNP 峰值及CTNI 峰值均低于择期组（P <0.05）。结论 急性前壁心肌梗死患者6 ～ 12 h 行急诊PCI 术或择期PCI 术，术后近期心功能均会一过性下降，择期组较急诊组下降更显著，提示患者发病>6 h 已无症状，行急诊PCI 术对患者术后心功能仍有积极作用，机制可能与急诊PCI 术尽早恢复血运重建，更早、更多地挽救存活心肌有关。

Clinical trial on postoperative heart function of emergency PCIand selective PCI in patients with AMI

Objective To evaluate the postoperative heart function of patients with acute anterior myocardialinfarction (AMI) receiving emergency percutaneous coronary intervention (PCI) within 6-12 h of attack or selectivePCI. Methods Seventy-seven patients wih AMI were divided into an emergency PCI group (30 cases) and aselective PCI group (47 cases). The patients in the emergency PCI group received emergency PCI within 6 to 12hours after attack, the patients in the selective PCI group were treated by elective PCI (over 12 hours) after 7 to 10days. LVEDd, LVEF, NT-proBNP and cardiac troponin I (CTNI) were monitored on the day of admission, everyother day and 10 days later, then compared between the two groups. Results In the emergency PCI group, LVEDd atthe time of admission and discharge had no significant difference (P > 0.05), while the LVEF decreased at discharge(P < 0.05). In the selective PCI group, the LVEDd increased and LVEF significantly decreased at discharge (P < 0.05).The differences of LVEDd and LVEF at admission and discharge were significantly different between the two groups(P < 0.05). The NT-proBNP and CTNI levels of the emergency PCI group were significantly lower than those of theselective PCI group (P < 0.05). Conclusions The heart function will decline in a short time in the patients with AMIundergoing emergency PCI within 6-12 h of attack or selective PCI, but it decreases more in the selective PCI group than in the emergency PCI group, which indicates that emergency PCI operation within 6-12 h of attack has positiveeffect on the cardiac function of AMI patients. The mechanism may be that emergency PCI operation can providerevascularization as soon as possible and save more survival myocardium.