急性ST段抬高型心肌梗死患者不同再灌注方法的疗效差异  

Effective Comparison of Primary Percutaneous Coronary Intervention and Venous Thrombus Therapy in Patients with Acute ST Segment Elevation Myocardial Infarction

作　　者：黄艺仪[1] 何建桂[2] 陈胜龙[2] 

机构地区：[1]中山大学附属第一医院急诊科,510080 [2]中山大学附属第一医院心脏病监护病房,510080

出　　处：《岭南急诊医学杂志》2009年第5期344-346,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:比较直接经皮冠脉介入治疗(直接PCI)与静脉溶栓治疗急性ST段抬高型心肌梗死患者的疗效。方法:回顾分析我院收治的急性心梗并行再灌注治疗243例患者的临床资料,根据再灌注方法分为直接PCI组(A组,n=198)和静脉rt-PA溶栓组(B组,n=45),比较两组病人住院期间的主要临床事件结果。结果:在平均住院日、出院时血浆BNP改善率及左室射血分数(LVEF)上,直接PCI组均优于静脉溶栓组(P<0.05);心肌再梗以及心源性死亡的发生率在直接PCI组明显降低(P<0.05)。但年龄小于65岁,或发病在3h内的患者,两种干预方法的近期死亡率无统计学差异。静脉溶栓组患者就诊至开始干预治疗时间明显短于直接PCI组(P<0.01),且静脉溶栓组未作择期PCI的患者其治疗费用明显降低(P<0.01)。结论:直接PCI在治疗急性ST段抬高型心梗患者的总体效果优于静脉溶栓疗。但静脉溶栓起效快、费用低;对发病在3 h内的患者,两种再灌注方法近期疗效相近。Objective:To compare the effects of primary percutaneous coronary intervention (PCI)and venous thrombolytic therapy in patients with acute ST segment elevation myocardial infarction.Methods:Retrospective analysis of hospital admissions,in parallel with acute myocardial infarction and reperfusion therapy patients,a total of 243 cases,according to method of reperfusion were divided into Emergency PCI group (A group,n=198) and intravenous rt-PA thrombolysis group (B group,n=45),compared two groups of patients the main clinical events during hospitalization outcome.Results:Comparing with the venous thrombus therapy,Emergency PCI had significant advantage in the time of hospitalization,the improvement rate of serum BNP level,left ventricular ejective fraction (LVEF),the rate of reinfarction and cardiogenic death (P<0.05).However,the above indexes had no significant difference in the patients whose age was less than 65 years treated by the two methods.So as to the patients whose chest pain symptom happened within 3 hours.Nevertheless,venous thrombus therapy could significant decreased the therapeutic cost that the patients were not accepted rescue PCI and shortened the time to treatment (TT) (P<0.01). Conclusions:The effects of Emergency PCI significantly surpass the venous thrombus therapy in patients with acute ST segment elevation myocardial infarction.However,rapid onset of thrombolytic therapy and low-cost,pairs of onset of patients in 3 hours,both reperfusion methods similar short-term effect.

关 键 词：高型 心肌梗死患者 灌注方法 疗效差异 Myocardial INFARCTION Coronary Intervention Comparison 静脉溶栓治疗 直接经皮冠脉介入治疗 PCI 左室射血分数 再灌注治疗 心源性死亡 统计学差异 平均住院日 住院期间 治疗时间 治疗费用 急性心梗 临床资料 

分 类 号：R542.22[医药卫生—心血管疾病]