急诊冠状动脉介入与溶栓治疗急性心肌梗死临床疗效的比较  

Comparison the Clinical Efficacy of Direct Percutaneous Coronary Intervention with Thrombolytic Therapy in Acute Myocardial Infarction

作　　者：任凤学[1] 刘义秀 尹吉东 杨珍珍[1] 吴永辉[1] 温静霞[1] 

机构地区：[1]航空工业中心医院心内科,北京100012

出　　处：《中国医药导刊》2006年第4期253-254,共2页Chinese Journal of Medicinal Guide

摘　　要：目的:比较急诊冠状动脉介入治疗(PCI)与溶栓治疗急性心肌梗死(AMI)的临床疗效。方法:选择首次AMI患者, 128例患者接受直接PCI治疗,其中30例溶栓后行补救PCI。83例患者接受静脉溶栓治疗,45例溶栓患者48小时内行冠状动脉造影检查,比较两组患者住院期间的临床情况。结果:溶栓组院内死亡率高于直接PCI组(P<0．05)．溶栓组血管再通率为68．6％,梗死相关血管(IRA)达到TIMIⅢ级血流者为60．5％,直接PCI组血管再通率96．8％,有4例发生无再流现象(No-reflow)．AMI后2周左室射血分数溶栓组为(49．3±12．1)％,直接PCI组为(64．2±9．6)％,两组有显著性差异(P <0．05)．平均住院天数溶栓组为13．4天,直接PCI组为8．2天,两组有显著性差异(P<0．05)．结论:与溶栓治疗比较,首次AMI患者直接PCI治疗,梗死相关血管(IRA)开通率高,可更好的改善患者的心功能,降低院内死亡率,缩短住院天数。Objective：To compare the clinical efficacy of direct percutaneous wansluminal coronary intervention （PCI） with thrombolytic therapy in acute myocardial infarction（AMI） .Methods： 128 cases of first AMI were treated by direct PCI while 83 cases were treated by thrombolytic therapy with UK or r - tPA, clinical outcomes was assessed during hospitalization. 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 68.6%, and TIMI grade 3 flow of infarct related artery（IRA） was obtained in60.5%while in those with direct PCI the vessel reperfusion rates was96.8%, In direct PCI group, there are 4 cases with no - reflow.There was significant differences in left ventricular ejection fraction（LVEF） 2 weeks after AMI between thrombolytic therapy group and direct PCI group[ （49.3 ± 12.1 ） % vs （64.2 ± 9.6 ） %, P 〈 0.05 ]. There was significant differences in average days of hospitalization between thrombolytic therapy group and direct PCI group （ 13.4vs8.2, P 〈 0.05）. Conclusion： Direct PrCA was more effective than thrombolytic therapy in improving cardiac function and lower mortality due to complete and effective reperfusion of IRA after AMI.

关 键 词：急性心肌梗死 冠状动脉介入治疗 溶栓治疗 

分 类 号：R542.22[医药卫生—心血管疾病]