重组组织型纤溶酶原激活剂加补救性冠状动脉介入术与直接冠状动脉介入术对急性心肌梗死的疗效研究  

Comparison of the Reperfusion Arrhythmia in the Recombinant Tissue Plasminogen Activator plus Rescue Coronary Interventional Procedures and Primary Coronary Interventional Procedures in Acute Myocardial Infarction

作　　者：李方[1] 孙哲[1] 王志新[2] 郭涛[3] 吴会芳[3] 李琮宇[4] 

机构地区：[1]郑州大学第五附属医院,郑州450052 [2]河南大学医学院神经生物研究所,开封475100 [3]郑州大学基础医学院河南省食管癌重点开放实验室,郑州450052 [4]河南省肿瘤医院,郑州450008

出　　处：《中国医药导刊》2008年第4期578-580,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:对比急性心肌梗死(AMI)患者应用重组组织型纤溶酶原激活剂(rt-PA)治疗,加补救性经皮冠状动脉腔内成形术(PTCA)或冠状动脉内支架(STENT)置入术与直接PTCA/STENT置入术的临床疗效。方法:68例首次AMI患者随机给予静脉rt-PA溶栓加补救性PTCA/STENT(A组)和直接PTCA/STENT(B组)。44例患者用阿司匹林和肝素后,接受治疗,19例直接PTCA和支架。术中分别应用冠状动脉造影(CAG)定位梗塞相关动脉(IRA)。多道心电生理仪观察再灌注性心律失常,根据不同的心律失常类型予以相应的处理。术后10～20d两组病人均做超声心动图,对比左心室射血分数(LVEDP)以评价心肌功能恢复的情况。结果:(1)首次CAG显示A组IRA51支,其中左前降支(LAD)29支,右冠状动脉(RCA)15支,左回旋支(LCX)7支;B组IRA24支,其中LAD13支,RCA7支,LCX4支;两组冠状动脉分支梗塞率相比无显著差异(P>0.05)。(2) AB两组行静脉rt-PA溶栓加补救性PTCA/STENT和直接PTCA/STENT术中再灌注性心律失常发生率,A组为25%(11/ 44),其中心室颤动发生事为14%(6/44);B组为79%(15/19),其中心室颤动发生率为53%(10/19)。两组再灌注性心律失常的发生率及心室颤动发生率相比均有显著性差异(P<0.05)。两组心室颤动病人行电除颤后转复为窦性心率。(3)病人住院10～20d,二维超声心动图显示,LVEDP达到或超过60%者,A组为64%(28例),B组为89%(17例)。两组相比有显著性意义(P<0.05)。结论:静脉rt-PA溶栓加补救性PTCA/STENT和直接PTCA/STENT相比较,前者较后者治疗时间提前,再灌注性心律失常明显,急性期过后,病人心肌功能恢复的好。Objective： To compare the occurrence rate of the reperfusion arrhythmia in the recombinant tissue plasminogen activator plus rescue coronary interventional procedures and primary coronary interventional procedures and the left ventricular ejection function after the recombinant tissue plasminogen activator plus rescue coronary interventional procedures and primary coronary interventional procedures in the acute myocardial infarction（AMI）. Methods： 68 consecutive patients with AMI were randomly treated with intravenous rt - PA 50mg therapy plus rescue PTCA/STENT （ group A ） or with primary PTCA/STENT （ group B ）. 44of 135 patients received rt - PA 50mg after aspirin and heparin from August 2002 to December 2003. Primary PTCA/STENT was in the other 19 patients, The IRA was orientated by CAG （the coronary angiography）. Results： （1）The difference between group A and group B about infarct related artery（IRA） was not significant（ P 〉 0. 05 ）. （2）The difference between group A and group B about the rate of reperfusion arrhythmia and ventricle tremble was significant （P 〈 0. 05 ）. （3）At 10 -20 days follow -up, The difference between group A and group B about left ventricular ejectin function was significant （ P 〈 0. 05 ）. Conclusion： Compared with the effect of primary PTCA/STENT, the thrombolytic agent rt - PA 50mg plus rescue PTCA/STENT in AMI was treated by earlier, the reperfusion arrhythmia in operation was more obvious and a well recovery of the myocardial function after acute period was made.

关 键 词：急性心肌梗死 再灌注性心律失常 经皮冠状动脉腔内成形术 冠状动脉内支架术 

分 类 号：R542.22[医药卫生—心血管疾病]