补救性冠状动脉介入术与直接冠状动脉介入术治疗急性心肌梗死的临床分析  

Intravenous thrombolysis plus rescue intracoronary intervention compared with primary intracoronary stenting in treating acute myocardial infarction

作　　者：丁士芳[1] 李继福[1] 陈玉国[1] 张运[1] 刘黎明[2] 李贵双[1] 纪求尚[1] 刘同涛[1] 

机构地区：[1]山东大学齐鲁医院心内科,山东济南250012 [2]山东大学第二医院急诊科,山东济南250033

出　　处：《山东大学学报（医学版）》2005年第9期795-798,共4页Journal of Shandong University:Health Sciences

基　　金：卫生部临床学科重点项目(No.20012943);山东省科委重点项目(2002BB1CJA1);山东省卫生厅科研基金资助课题(2001CAICAAB3)

摘　　要：目的:评价急性心肌梗死(AMI)患者溶栓失败后进行补救性经皮冠状动脉介入术(PCI)与直接PCI的临床疗效。方法:196例AMI患者进行直接PCI治疗(直接PCI组),34例静脉溶栓失败的AMI患者进行补救性PCI治疗(补救PCI组)。观察两组患者的基本特征、冠状动脉造影特点及支架置入情况,比较住院与随访期间主要心血管事件的发生情况,判断其疗效。结果:与直接PCI组相比,补救PCI组年龄偏低[(52.47±11.93)岁vs(60.28±11.02)岁,P=0.001],较少伴有高血压(32.4%vs56.1%,P=0.01)。两组患者梗死相关动脉(IRA)的分布、病变形态、冠脉病变支数无差异性(P均>0.05);直接PCI组“罪犯”病变狭窄程度较补救PCI组重[(95.47±7.83)%vs(90.73±11.02)%,P<0.05];置入支架的直径小[(3.07±0.41)mmvs(3.23±0.39)mmCP<0.05];直接PCI组IRA开通率偏低(89.8%vs100%CP>0.05)。两组患者血运重建程度有差别(P<0.05),但近期与远期心血管事件发生率无差异(P均>0.05)。结论:补救性PCI与直接PCI均是AMI有效的再灌注治疗措施。Objective： To compare the effects of primary percutaneous coronary intervention （PCI） and thrombolysis plus rescue PCI on acute myocardial infarction （AMI）. Methods： One hundred and ninety-six patients with first AMI were treated with primary intracoronary stenting （primary PCI group）, 34 patients after failed thrombolysis were treated with rescue PCI （rescue PCI group）. The baseline characteristics, coronaryangiogram and major cardiovascular events were compared with each other in the two groups. Results： The age [（52.47±11.93） years vs （60.28±11.02） years, P=0.001] and history of hypertension （32.4% vs 56.1%, P= 0.01） were significant difference between primary PCI and rescue PCI groups. There were no significant differences in infarct location, time from onset of symptom to hospital presentation and time from hospital presentation to reperfusion therapy, type of infarct related artery （IRA）, lesion type and IRA patency （89.8% vs 100%） between two groups; but apparent differences were found in IRA stenosis [（95.47±7.83）% vs （90.73± 11.02）%], stent diameter [（3.07±0.41）mm vs （3.23±0.39）mm] between two groups. The occurrence of major cardiovascular events were not different in in-hospital and follow-up between two groups.Conclusion： Primary PCI and rescue PCI are safe and effective with a high successful rate and few complications for AMI.

关 键 词：心肌梗塞 血管成形术 经腔 经皮冠状动脉 支架 

分 类 号：R542.2[医药卫生—心血管疾病]