静脉溶栓和直接经皮冠脉腔内成形术治疗发病3h后急性心肌梗死的疗效比较  

Comparision of direct PCI and thromblytic(urokinase) for acute myocardial infarction beyond three hours:healing effect

作　　者：姜威锋[1] 王大钊[1] 李学辉[1] 王立旗[1] 

机构地区：[1]开封市第二人民医院心内科,河南开封475000

出　　处：《中国医学工程》2010年第3期22-24,27,共4页China Medical Engineering

摘　　要：目的对比静脉尿激酶溶栓(UK)和直接冠状动脉内介入治疗(PCI)治疗发病3h后急性心肌梗死(AMI)的临床疗效。方法 109例发病3h后AMI患者,61例接受静脉溶栓治疗,48例接受PCI治疗。比较两组住院期间临床结果及超声心动图结果。结果直接PCI组:IRA开通率(95.9%)高于UK组(61.2%),P﹤0.05;心衰发生率12.1%,严重心律失常发生率8.1%,心源性休克发生率2.7%,病死率2.7%,均低于PCI组(分别为25.0%,20.0%,10.0%,11.1%,两组比较有显著差异,P﹤0.05)。UCG检查:室壁矛盾运动发生率直接PCI组为2.7%,低于UK(12.7%),P﹤0.05;而左室射血分数LVEF%直接PCI组为56.8±8.3),高于UK组51.2±10.4,两组比较P﹤0.05。而两组中出血率、再发心绞痛率和再闭塞率无明显差别(P>0.05)。结论与UK治疗相比,直接PCI治疗发病3h后AMI疗效更佳,可减少心衰及心脏恶性事件发生率和病死率,改善预后。【Objective】To compare the healing effect direct percutaneous coronary intervention（PCI） and thrombolytic therapy（Urokinase,UK） in patients wish acute myocardial infarction（AMI） of three hour later.【Methods】Among one hundred and nine consecutive patients with AMI,sixty one cases were treated with thrombolytic therapy（UK）,but 48 cases were treated with direct PCI.We compared the results of clinical effects and ultrasonic cardiogrape（UCG） in hospital.【Results】In direct PCI groups,the recanalizing rate of infarct related artery（IRA） was significantly higher than those in Ukgroups（95.9% vs 61.2%）,P ﹤ 0.05;but the incidences of heart failure,malignant arrhythmia,cardiogenic shock and mortality in PCI groups were lower than those in UK groups.（12.1% vs 25.0%,8.1% vs 20.0%,2.7% vs 10.0%,2.7% vs 11.1% ;P ﹤ 0.05,respectively for all）.The UCG examination showed that the rate of dyskinesia in PCI groups were significantly lower than those in UK groups（2.7% vs 12.7%,P ﹤ 0.05）.While LVEF（%） in PCI groups were significantly higher than those in UK groups（56.8 ± 8.3 vs 51.2 ± 10.4,P ﹤ 0.05）.There were no significant differences in the rate of bleeding,recurrent angina and re-occlusion between the two groups.【Conclusion】This study showed that direct PCI is more effective than thrombolytic therapy in preserving cardiac function,reducing the rate of heart failure and malignant cardiac events,improving the prognosis of AMI beyond three hours.

关 键 词：急性心肌梗死 经皮冠状动脉腔内成形术 溶栓治疗 

分 类 号：R541.4[医药卫生—心血管疾病]