小剂量静脉溶栓加冠脉内支架置入术治疗急性心肌梗死的临床效果  

The effect of low-dose thrombolysis followed by back-up tracoronary stent implanting for acute myocardial infarction

作　　者：田声放[1] 孙元芬[1] 潘巍巍[1] 赵筠荃[1] 武越[1] 

机构地区：[1]青岛市立医院心内科,山东省青岛市266001

出　　处：《中国心血管病研究》2006年第8期579-581,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨小剂量静脉溶栓后追加冠脉内支架置入术治疗急性心肌梗死(AMI)的临床疗效和安全性。方法将发生AMI6h以内的112例患者随机分为溶栓+支架组和单纯支架组。对两组介入治疗前冠脉造影中血管TIMI3级的开通率、支架置入成功率、安全性及介入治疗后左室射血分数情况进行了比较。结果在冠脉造影中血管TIMI2级和3级的开通率,溶栓+支架组为67.8%,对照组为16.1%,差异有统计学意义(P<0.05)。3个月后溶栓+支架组左室射血分数有明显高于对照组的倾向[(59.2±11.2)%v(s50.6±10.9)%,P<0.05]。支架置入成功率和出血性合并症两组差异无统计学意义。结论小剂量静脉溶栓+支架置入治疗可以明显增加急性心肌梗死早期冠脉开通率,保护左心室功能,且不增加出血性并发症,是安全、有效获得再灌注的方法。Objective The aim of this study was to elucidate the efficacy and safety of the injection of a low-dose recombinant tissue-type plasminogen activator （rt-PA）, followed by back-up in tracoronary stent implanting in patients with acute myocardial infarction（AMI）. Methods The 112 patients with AMI who were admitted to hospital within 6 hours of onset of symptoms were randomiy assigned to a treatment with 50 mg bolus rt-PA group （group T, n=56） and no rt-PA group （group P,n=56）, followed by back-up intracoronary stent implanting. The results of angiography, success rate of intracoronary stent implanting, left ventricular end-diastolic volume and left ventricular ejection were compared in two groups. Results The coronary angiographies showed that the blood flow of coronary reaching TIMI grade Ⅱ and grade Ⅲ was significantly higher in group T than in group P （ 67.8% vs 16.1%, P〈0.05）. The success rate of intracoronary stent implanting was 100% ingroup T, while 96.9% in group P. The left ventricular ejection after 3 months was significantly higher in gsoup T than in gsoup P[（59.2±11.2）% vs （50.6±10.9）%, P〈0.05]. The bleeding comlications were of no significant vaviation. Conclusion These findings explain the treatment with 50 mg bolus rt-PA followed by back-up in tracoronary stent implanting is effective for the early reperfusion and preservation of left ventricular function, without increasing of bleeding complications in patients with AMI.

关 键 词：心肌梗塞 血栓溶解疗法 血管形成术 经皮 经腔冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]