急性心肌梗死静脉溶栓后介入治疗与直接介入治疗的比较研究  

Comparison Study on Percutaneous Coronary Intervention Combined with Intravenous Thrombolysis and Direct Percutaneous Coronary Intervention in Acute Myocardial Infarction

作　　者：林青[1] 万征[1] 李晓春[1] 张文娟[1] 蔡衡[1] 于向东[1] 李永乐[1] 张殿芬[1] 周炎[1] 程晔[1] 孙跃民[1] 黄灿亮[1] 

机构地区：[1]天津医科大学总医院心脏内科,300052

出　　处：《天津医药》2006年第6期372-375,共4页Tianjin Medical Journal

摘　　要：目的:比较急性心肌梗死(AMI)患者应用静脉溶栓治疗后经皮冠状动脉介入治疗(PCI)与直接PCI的临床疗效。方法:125例发病12h内且无溶栓禁忌证的初发AMI患者根据处理措施分为溶栓加PCI组(47例),静脉给予重组组织型纤溶酶原激活剂或尿激酶溶栓后行冠状动脉造影(CAG),以心肌梗死溶栓治疗临床试验(TIMI)血流分级法评估,进行补救或延迟PCI;直接PCI组(78例),进行直接PCI。对两组患者梗死相关动脉(IRA)开通率、支架植入成功率和出血等并发症发生率、住院期间不良心脏事件发生率及PCI后4周超声心动图测定的两组患者左室射血分数(LVEF)进行比较。结果:到达导管室时IRA已达TIMI3级血流者27例,其中溶栓加PCI组19例(40.4%)高于直接PCI组的8例(10.3%),差异有统计学意义。两组患者IRA支架植入术的成功率差异无统计学意义。住院期间两组均无严重出血并发症发生。术后4周左心室功能溶栓加PCI组LVEF为(59.8±7.3)%,高于直接PCI组的(51.4±8.1)%,差异有统计学意义(P<0.05)。其中溶栓加PCI组PCI术前已达TIMI3级血流者4周后LVEF明显好于直接PCI者(P<0.05)。结论:静脉溶栓联合介入疗法治疗AMI早期IRA再通率高,更有利于保护左心室功能,并降低心脏事件的发生,是值得考虑的AMI早期再灌注治疗策略。Objective; To compare the efficacy and safety of percutaneous coronary intervention （PCI） combined with intravenous thrombolysis and direct PCI in acute myocardial infarction （AMI）. Methods： One hundred and twenty-five patients with first AMI （≤ 12 h from onset） and without contraindication to thrombolytic therapy were randomly divided into thrombolysis plus PCI group （47 cases） and direct PCI group （78 cases）.The patency rate of infarct-related artery （IRA） after intervention, the procedural success rate, the incidence of bleeding complications, the incidence of acute ischemia event during hospitalization and the left ventricular ejection fraction （LVEF） measured by echocardiography 4 weeks after PCI were compared. Results： IRA achieved TIMI flow grade 3 in 27 cases, including 19 cases in the thrombolysis plus PCI group （40.4%） which was significantly higher than that in the direct PCI group （8 cases, 10.3%） ,there was a significant difference between the two groups （P 〈 0.05）. There was no significant difference of the procedural success rate after PCI between 2 groups. No serious hemorrhage complication was found during hospitalization in 2 groups. LVEF 4 weeks after PCI in thrombolysis plus PCI group （59.8±7.3）% was higher than that in the direct PCI group （51.4±8.1）%, there was a significant difference between the two groups （P 〈 0.05）. LVEF 4 weeks after PCI in TIMI flow grade 3 cases in thrombolysis plus PCI group was higher than that in the direct PCI group （P 〈 0.05）. Conclusion： Intravenous thrombolysis combined with interventional therapy for AMI is safe and effective with a higher early patency rate, better cardiac function and reduced cardiac events.

关 键 词：心肌梗塞 急性病 血栓溶解疗法 静脉 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病] R654.2[医药卫生—内科学]