2026 年第 10 期 第 21 卷

预防性应用乳果糖对急性ST段抬高型心肌梗死患者院内主要不良心血管事件的影响

Effect of prophylactic lactulose administration on in-hospital major adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction

作者：王海科1赛迪妮萨·如则麦麦提1王梦华2贾立昕3周世英1

英文作者：Wang Haike1 Saidinisa Ruzemaimaiti1 Wang Menghua2 Jia Lixin3 Zhou Shiying1

单位：1新疆维吾尔自治区和田地区人民医院急诊医学科冠心病监护病房，和田848000；2新疆维吾尔自治区和田地区第二人民医院重症监护病房，和田848000；3首都医科大学附属北京安贞医院心力衰竭中心，北京100029

英文单位：1Department of Emergency Medicine Coronary Care Unit People′s Hospital of Hotan Prefecture Xinjiang Uygur Autonomous Region Hotan 848000 China; 2Intensive Care Unit the Second People′s Hospital of Hotan Prefecture Xinjiang Uygur Autonomous Region Hotan 848000 China; 3Heart Failure Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性ST段抬高型心肌梗死；乳果糖；排便管理；主要不良心血管事件；需治人数

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Lactulose;Defecationmanagement;Majoradversecardiovascularevents;Numberneededtotreat

• 摘要：

• 目的  探讨预防性应用乳果糖对急性ST段抬高型心肌梗死（STEMI）患者院内主要不良心血管事件（MACE）及出院后全因死亡率的影响。方法 连续纳入2023年5月至2024年10月于新疆维吾尔自治区和田地区人民医院收治的发病≤3 d的急性STEMI患者，按大致1∶1比例随机分为观察组（50例）和对照组（51例）。对照组接受指南的常规治疗及生活方式干预，观察组在常规治疗的基础上，联合乳果糖口服溶液干预。比较2组住院期间排便情况与MACE发生率，并于出院后30 d及180 d进行随访，比较2组出院后全因死亡率。结果 首次排便时，观察组排便费力和便干硬的发生率分别为2.0%（1/50）和0(0/50)，显著低于对照组的15.7%(8/51)和11.8%(6/51)（均P＜0.05）。住院观察期内，对照组发生MACE 11例（21.6%），观察组发生2例（4.0%），对照组MACE发生率显著高于观察组（χ2=6.949,P=0.008）。Kaplan-Meier生存曲线结果显示，住院观察期内观察组MACE发生率显著低于对照组（Log-rank χ2=9.498,P=0.002）。排便过程MACE分析显示，对照组发生MACE 8例（15.7%），观察组发生1例（2.0%），对照组MACE发生率显著高于观察组（P=0.031）。排便观察期绝对风险降低率为13.7%，即预防1例排便过程出现的心血管事件需治人数=7.3。出院后30 d及180 d时，2组全因死亡率差异均无统计学意义（P=1.000、0.436）。结论 预防性应用乳果糖可有效改善STEMI急性期排便困难，并显著降低院内MACE风险，可作为急性期肠道管理的有效辅助手段。

• Objective To investigate the effect of prophylactic lactulose administration on in-hospital major adverse cardiovascular events (MACE) and post-discharge all-cause mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Consecutive acute STEMI patients with disease onset ≤3 d admitted to People′s Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region from May 2023 to October 2024 were enrolled, and randomly divided into observation group (50 cases) and control group (51 cases) at a approximately 1∶1 ratio. The control group received guideline-recommended routine therapy and lifestyle intervention, while the observation group additionally received oral lactulose solution on the basis of routine therapy. Defecation status and the incidence of in-hospital MACE were compared between the two groups. Follow-up was performed at 30 d and 180 d after discharge to compare post-discharge all-cause mortality. Results At the first defecation, the incidences of straining during defecation and hard stools in the observation group were 2.0%(1/50) and 0(0/50), which were significantly lower than 15.7% (8/51) and 11.8% (6/51) in the control group (both P＜0.05). During hospitalization, 11 cases (21.6%) of MACE occurred in the control group versus 2 cases (4.0%) in the observation group; the incidence of MACE was significantly higher in the control group (χ2=6.949, P=0.008). Kaplan-Meier survival curves showed that the in-hospital MACE incidence in the observation group was markedly lower than that in the control group (Log-rank χ2=9.498, P=0.002). Analysis of MACE during defecation showed 8 cases (15.7%) in the control group and 1 case (2.0%) in the observation group, with a significantly higher MACE incidence in the control group (P=0.031). The absolute risk reduction during defecation observation period was 13.7%, and the number needed to treat to prevent one cardiovascular event during defecation was 7.3. There was no statistically significant difference in all-cause mortality between the two groups at 30 d and 180 d after discharge (P=1.000, 0.436). Conclusion Prophylactic lactulose can effectively ameliorate defecation difficulty in the acute phase of STEMI and significantly reduce the risk of in-hospital MACE, which can serve as an effective adjunctive measure for intestinal management in the acute phase.