溶栓后延迟冠状动脉介入治疗急性心肌梗死的疗效研究  

Curative Effect Study on Delay Percutaneous Coronary Artery Intervention for Acute Myocardial Infarction after Intravenous Thrombolysis Therapy

作　　者：程标[1] 蔡力[1] 张代富[1] 姜荣建[1] 罗云[1] 孔鸿[1] 舒燕[1] 

机构地区：[1]四川省人民医院心内科,四川成都610072

出　　处：《职业卫生与病伤》2006年第3期187-189,共3页Occupational Health and Damage

摘　　要：目的探讨急性心肌梗死患者溶栓后延迟经皮冠状动脉介入治疗（PCI）的临床疗效。方法34例患者接受尿激酶150万单位或200万单位治疗后，7～10d行冠状动脉造影，以心肌梗死溶栓治疗临床试验（TIMI）血流分级法评估，必要时做PCI。观察患者的梗死相关动脉开通率，并发症发生率、病死率、早期与最后心肌梗死面积（4周后）及左心室射血分数。结果溶栓后梗死相关动脉开通率为52．9％，患者首次造影时梗死相关动脉已达TIMI3级血流者23．5％（8／34例），经PCI变为TIMI3级血流者32例（94．1％）；住院后4周左心室射血分数较治疗前显著改善，造影显示溶栓已达TIMI3级血流者左心室射血分数明显好于未达TIMI3级者；最后与早期心肌梗死面积差异有统计学意义；复合原因（心绞痛、心功能不全、室性心律失常）住院率低，住院死亡率0％。结论尿激酶溶栓延迟PCI治疗急性心肌梗死，可使部分患者梗死相关动脉尽早开通，有利于保护急性心肌梗死患者的左心室功能，减少心绞痛发作及再次住院率。Objective To observe the clinical curative effect of delay percutaneous coronary intervention （PCI） after intravenous thrombolysis in the treatment of acute myocardial infarction （AMI）. Methods Thirty- four patients with AMI were treated with delay PCI after receiving UK 1, 500, 000 or 2, 000, 000 units. TIMI blood flow grade was assessed by coronary angiography （CAG） after 7-10 d, and if neeessary, PCI was adopted. The reperfusion rate of infarction related artery （IRA）, the incidence of complication, the mortality, the area of AMI during the therapy, the left ventricular ejection fraction （LVEF） and in- hospital rate were observed. Results The reperfusion rate of IRA after intravenous thrombolysis therapy was 52.9% , IRA was in TIMI flow grade 3 in 8 patients （23.5%） on the first CAG. , after PCI, TIMI 3 was achieved in 32 （94. 1%） . Four weeks after hospitalization, LVEF was significantly improved than that before therapy. The angiography showed LVEF of patients whose thrombolysis had reached TIMI flow grade 3 was significantly better than those who did not reach grade 3. There were statistical significance between early and final infarct size. The rate of in- hospital because of multiplicity reasons （AP, cardiac inadequacy, VA） was low. The mortality during hospitalization was 0 %. Conclusions The initial results showed that delay PCI for AMI can make IRA patent as early as possible in some patients, improve left ventricular function and reduce angina pectoris attacks and the inhospital rate.

关 键 词：心肌梗死 尿激酶 经皮冠状动脉介入治疗 疗效 

分 类 号：R542.2[医药卫生—心血管疾病]