急性心肌梗死用瑞替普酶溶栓后早期行补救性PCI的疗效及安全性临床观察  

Clinical observation of effect and safty on acute myocardial infarction patients treated with rescue percutaneous coronary intervention early after thrombolysis with Reteplase

作　　者：张明秋[1] 刘胜全[1] 张桂华[1] 

机构地区：[1]吉林大学中日联谊医院心内科,吉林长春130031

出　　处：《吉林医学》2006年第11期1335-1337,共3页Jilin Medical Journal

摘　　要：目的:应用第三代溶栓药物瑞替普酶冶疗急性心肌梗死,对未能溶通的病例,及时进行补救性经皮冠脉成形术(PCI),评价其疗效及安全性。方法:自2002年3月～2005年3月,共计30例患者,男性21例,女性9例,年龄41～65岁,其中前壁心肌梗死18例,前壁伴下壁或高侧壁心肌梗死7例,急性下壁心肌梗死5例。发病6h内,用瑞替普酶溶栓治疗,溶栓后2h内,未出现再灌注心律失常、心绞痛未缓解或加重者;心电图抬高的ST段回降<50%。进行冠脉造影,显示闭塞90%以上狭窄病变,同时进行冠脉支架置入术,至术后35d,观察病死率,心力衰竭发生率,血管重建;并且与既往入我科诊断急性心肌梗死经溶栓治疗,未溶通的30例病例做比较。结果:30例应用瑞替普酶溶栓后补救性PCI的患者与对照组比较,成功率96.7%,35d内病死率(0;20,P<0.00l);心力衰竭发生率(3.4%;65%),血管重建率(0;33%),大出血发生率(3.3%;0)。结论:用瑞替普酶溶栓后对未溶通的患者行补救性PCI,初步认为是有效的、安全的。Objective To evaluate the therapeutic effect and salty of timely treating with rescue percutaneous coronary intervention（PCI） on acute myocardial infarction（AMI） patients who were thrombolized with Keteplase but failed. Method 30 cases of AMI （21 cases of male and 9 cases of female, the age between 41 and 65 years） who were in-hospiud between March 2002 and March 2005 were observed and treated with Reteplase within 6 hours after AMI onset. Among them, 18 cases of anterior wail AMI, 7 cases of anterior wall and inferior or high lateral wall AMI and 5 cases of inferior wall AMI. If the patients did not show reperfusion arrhythmia, the pain could not be released or aggravated, the ST segment dropped less than 50% in 2 hours aider thrombolysis and angingram displayed 90% stenosis, we would treat them with rescue PCI. We observed the case fatality rate, the heart failure incidence and revascularization rate 35 days later, and contrasted them with that of 30 AMI cases who treated with failed thrombolysis, but did not receive rescue PCI. Results Contrasted with the normal control group, the successful rate in the rescue PCI group was 96.7%, the mortality rate in 35 days of the two groups were 0% and 20% respectively （P〈0.001）, the heart failure rate were 3.4% and 65%, revascularization rate were 0% and 33% and haemorrhagic rate were 3.3% and 0%. Conclusion Rescue PCI is effective and safe for AMI patients treated with thrombolysis but failed.

关 键 词：急性心肌梗死 瑞替普酶 补救性经皮冠脉成形术 

分 类 号：R542.22[医药卫生—心血管疾病]