急性心肌梗死直接冠状动脉内介入治疗与溶栓治疗的研究

目的比较直接经皮冠状动脉内介入治疗 (PCI)与静脉溶栓治疗急性心肌梗死 (AMI)患者近期和长期的临床疗效。方法入选AMI患者 4 7例 ,2 5例患者接受静脉溶栓治疗 ,2 2例患者接受直接PCI治疗 ,比较两组患者临床和住院期间及随访期间超声心动图结果。结果溶栓组住院死亡率高于直接PCI组 (P <0 .0 5 )。溶栓组血管再通率为 5 2 0 % ;直接PCI组血管再通率为 10 0 % ,达到TIMI 3级血流。AMI后 1周左室射血分数 (LVEF) :溶栓组为 4 4 3± 11 6 % ,直接PCI组为 6 4 5±9 1% ,两组比较有显著性差异 (P <0 .0 5 )。溶栓成功者其AMI后 1周LVEF也明显低于直接PCI组 (47 2± 9 6 %VS 6 4 5± 9 1% ,P <0 .0 5 )。溶栓组因溶栓失败行补救性PCI者为 2 4 0 % ,IRA开通率为 10 0 % ,其AMI后 1周及 3、6个月的LVEF略低于直接PCI组 ,但两组比较无显著性差异 (P>0 .0 5 )。溶栓组因存在梗死后心肌缺血症状行择期PCI的比率高于直接PCI组 ,两组比较有显著性差异 (2 8 0 %VS0 % ,P <0 .0 5 )。结论与溶栓治疗比较 ,直接PCI能使IRA安全有效充分开通 ,可更好地改善患者近期和长期心功能 ,降低住院死亡率。补救PCI也能有效地开通IRA ,获得TIMI13级血流 ,挽救濒死心肌 ,改善心功能。

The study of direct percutaneous coronary intervention with thrombolytic therapy in patients with acute myocardial infarction

Objective To compare the early and long term clinical effect of direct percutareous coronary intervention(PCI) with thrombolytic thrapy in patients with acute myocardial infarction(AMI). Methods 25 cases of AMI were treated by intravenous thrombolytic therapy with UK, while 22 cases of AMI were treated by direct PCI. Clinical outcomes and results of echocardiographic examination was assessed during hospitalization and follow-up period.Results Mortality during hospitalization was higher in thrombolytic therapy group than direct PCI group(P<0.05). In patients with thrombolytic therapy the vessel reperfusion rates was 52.0%, and TIMI grade 3 flow of infarct related artery(IRA) was obtained in 100% in direct PCI. There was significant differences in left ventricular ejection fraction(LVEF) 1 weeks after AMI between thrombolytic therapy group and direct PCI group (P<0.05). In the patients of obtaining successful thrombolytic therapy the LVEF was lower than that of direct PCI patients (P<0.05). Rescue PCI was done in 24.0% patients in thrombolytic group, and the reperusion rates of IRA was 100%. Conclusion Direct PCI is more effective than thrombolytic therapy in improving cardiac function and effective reperfusion of IRA after AMI.