急性心肌梗死后不同Killip分级患者直接冠状动脉介入治疗与溶栓治疗临床疗效的对比研究  

Comparison study of curative effect between direct PCI and thrombolysis in AMI patients with different cardiac function

作　　者：王占启[1] 傅向华[1] 马宁[1] 王爱平[1] 陈春红[1] 肖暖[1] 张晶[1] 

机构地区：[1]河北大学附属医院心内科,河北保定071000

出　　处：《中国急救医学》2007年第4期295-298,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的对比研究直接经皮冠状动脉介入(PCI)和溶栓这两种不同的血运重建治疗方法对急性心肌梗死(AMI)后不同心功能状态患者心室功能以及远期预后的影响。方法首次AMI患者166例,KillipⅡ～Ⅲ级组79例,其中43例行直接PCI治疗,36例予溶栓治疗;KillipⅠ级组87例,其中39例行直接PCI治疗,48例予溶栓治疗。观察所有入选患者AMI后1～2周主要心血管事件发生情况,并行ERNA检查。随访24周观察主要心血管事件发生情况,并于24周时复查ERNA。结果①与溶栓组相比,KillipⅡ～Ⅲ级AMI患者直接PCI组1～2周、24周时心室功能指标均明显改善;KillipⅠ级AMI患者直接PCI组心室功能指标略优于溶栓组,但差异无统计学意义。②KillipⅡ～Ⅲ级AMI患者住院1～2周、24周时再缺血事件发生率分别为9．3% vs 25．0%、18．6% vs 41．7%,直接PCI组较溶栓组显著降低(P＜0．05);KillipⅠ级AMI患者住院1～2周、24周时再缺血事件发生率分别为7．7% vs 12．5%、12．8% vs 22．9%,直接PCI组较溶栓组显著降低(P＜0．05)。结论KillipⅡ～Ⅲ级AMI患者直接PCI较溶栓治疗能更好地改善心室功能,而KillipⅠ级AMI患者直接PCI和溶栓治疗疗效相近。直接PCI术后再缺血血管事件发生率明显低于溶栓治疗。Objective To investigate the efficacy of direct percntaneous coronary intervention （PCI） and thrombolytic therapy in the acute myocardial infarction（AMI） patients with different cardiac function. Methods 166 patients with first AMI were devided into two groups according to Killip grade： Killip Ⅱ～Ⅲ group 79 cases, 43 cases with direct PCI treatment, 36 cases with thrombolytic treatment. Killip Ⅰ group, 87 cases, 39 cases with direct PCI treatment, 48 cases with thrombolytic treatment. All the patients underwent equilibrium radionuclide angiocardiography（ERNA） at 1 -2 weeks and 24 weeks after AMI. Left ventricular ejection fraction（ LVEF）, left ventricular peak filling rate（LPFR） were measured to evaluate left ventricular function. The major adverse cardiac events （ MACE ） were also recorded at 1 -2 weeks and 24 weeks after AMI. Results （1） Cardiac function of direct PCI at 1 ~ 2 weeks, 24 weeks were better in Killip Ⅱ～Ⅲ group than that of thrombolysis, and in Killip I group, the results were similar. 2）Compared with thrombolytic therapy, the incidences of re - ischemia were lower in direct PCI at 1 - 2 weeks and 24 weeks, in Killip Ⅱ～Ⅲ group： 9.3% vs 25.0%, 18.6% vs 41.7%, P 〈 0.05 ; In KillipI group： 7.7% vs 12.5%, 12.8% vs 22.9% ,P〈0.05. Conclusions （1）Compared with thrombolytic therapy, direct PCI treatment can improve the cardiac function of AMI patients with Killip Ⅱ～Ⅲ grade, while the results of direct PCI in AMI patients with KillipI grade were similar to thrombolytic therapy.（2The re - ischemia incidence of direct PCI was lower than that of thrombolytic treatment.

关 键 词：心肌梗死 血管成形术 经皮冠状动脉 血栓溶解疗法 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]