目的：探讨吸氧在行急诊经皮冠状动脉介入（percutaneous coronary intervention ，PCI）治疗不伴缺氧表现的急性心肌梗死（acute myocardial infarction ，AM I）患者中的治疗作用。方法：本研究为单中心的前瞻性随机对照研究。将纳入的143例拟行急诊PCI治疗、不伴缺氧表现的AMI患者分为吸氧组和对照组，吸氧组给予5 L／min流量的氧气吸入，对照组吸入空气，持续24 h。行PCI治疗前后，均采用标准化药物（抗栓及抗缺血药物＋他汀类药物＋血管紧张素转换酶抑制剂）治疗，且在冠心病监护病房（coronary care unit ，CCU）内进行监护。观察两组患者的AMI发病和PCI术中情况；入院时和出院时分别进行全球急性冠状动脉事件注册研究（Global Registry of Acute Coronary Events ，GRACE）评分，并检测血清肌钙蛋白I（cardiac tro‐ponin I ，CTnI）、肌酸激酶同工酶（myocardial‐specific isoenzyme of creatine kinase ，CK‐MB）和氨基末端脑钠肽前体（N‐terminal pro‐B‐type natriuretic peptide ，NT‐ProBNP）的峰值水平；记录患者发生心律失常、心源性休克和病死的例数以及住院时间。结果：吸氧组和对照组的心源性休克例数、病死例数和住院时间差异无统计学意义（均 P＞0．05）。吸氧组的血清CTnI和NT‐ProBNP峰值质量浓度分别为33．40（22．10，75．43）ng／mL和810（535，1390）pg／mL ，CK‐MB的峰值活性为（252．70±132．20）U／L ，均高于对照组的23．70（14．83，45．45）ng／mL、406（240，846）pg／mL和（189．66±97．05）U／L（均 P＜0．05）。吸氧组发生心律失常13例，高于对照组的9例（P＜0．05）。结论：不伴缺氧表现的AMI患者在急诊PCI治疗中，吸氧可能没有益处，甚至会加重心肌损伤。%Objective:To investigate the effects of oxygen therapy on patients with acute myocardial infarction (AMI) and without hypoxia ,who were treated with emergency percutaneous coronary intervention (PCI) .Methods:This study was a sin‐gle‐center ,prospective and randomized controlled study .A total of 143 patients with AMI and without hypoxia ,who were un‐dergoing emergency PCI were divided into oxygen group and control group .The patients in oxygen group inhaled oxygen at a flow rate of 5 L/min via nasal catheter for 24 hours ,the patients in control group inhaled air .Before and after PCI ,the patients in each group received standardized drug treatment (including anti‐thrombotic and anti‐ischemic drugs ,statins and angiotensin‐converting enzyme inhibitors) in Coronary Care Unit (CCU) .The situation of AMI and PCI were observed in the two groups . The clinical data including hospitalization time ,Global Registry of Acute Coronary Events (GRACE) score ,levels of cardiac troponin I(CTnI) ,myocardial‐specific isoenzyme of creatine kinase (CK‐MB) and N‐terminal pro‐B‐type natriuretic peptide (NT‐ProBNP) ,as well as the occurrence rates of cardiac arrhythmias ,cardiogenic shock and death were recorded and ana‐lyzed .Results:There were significant differences (all P<0 .05) between oxygen group and control group in peak concentra‐tions of serum CTnI[33 .40 (22 .10 ,75 .43) ng/mL vs .23 .70 (14 .83 ,45 .45) ng/mL] ,CK‐MB [(252 .70 ± 132 .20)U /L vs .(189 .66 ± 97 .05) U /L] and NT‐ProBNP [810(535 ,1390) pg/mL vs .406(240 ,846)pg/mL] as well as arrhythmia oc‐currence (13 vs .9 cases) .Bute there was no difference in cardiogenic shock ,death and hospitalization time between the two groups(all P>0 .05) .Conclusions:Oxygen therapy may have no benefit and even cause potential myocardial injury for AMI pa‐tients without hypoxia in the process of emergency PCI treatment .
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