老年高危急性心肌梗死行经皮冠状动脉介入治疗对临床转归的研究  

Effects of PCI on Clinical outcome of elderly patients with high - risk acute myocardial infarction

作　　者：张令刚 

机构地区：[1]立医院心脏科,山东省枣庄市277101

出　　处：《中国实用医刊》2011年第7期55-58,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨急诊经皮冠状动脉介入治疗（PCI）对高危急性心肌梗死患者近期病死率的影响。方法将637例经临床确诊的ST段上抬型、发病时间短于12h的急性心肌梗死患者分为急诊PCI（105例）、溶栓（94例）、药物（348例）三组，依据logistic回归方程高危急性心肌梗死患者的P值，各组又分别分为高危、低危2个亚组。以Timi血流分级判断急诊PCI梗死相关冠状动脉（IRA）开通、血栓、慢复流、无复流情况，记录住院期间临床事件，4周后用二维超声心动图测定左心室射血分数（LVEF），统计各组及亚组28d病死率。结果急诊PCI组IRA开通率为100％，支架率为99．O％；高危与低危两个亚纽术中冠脉内血栓发生率分别为25．03％、20．31％；慢复流发生率分别为30．12％、25．27％，无复流发生率分别为4．00％、0．00％（P均〉0．05）。临床事件发生率：出血：三组及亚组间比较差异无统计学意义（P〉0．05）。心力衰竭：药物组及亚组显著高于急诊PCI、溶栓组及亚组（P均〈0．01）。心绞痛；再梗死：溶栓组及亚组较急诊PCI、药物组及亚组高（P〈0．05或P〈0．01）。急诊PCI组及亚组住院天数明显缩短（P〈0．01）。LVEF：药物纽及亚组较急诊PCI、溶栓纽及亚组下降（P均〈0．05）。三组28d病死率分别为O％（0／105），7．46％（7／94），18．72％（82／438）（P〈0．05或P〈0．01）；高危亚组病死率分别为0％（0／74）、10．45％（7／67）、26．03％（82／315）（P〈0．05或P〈0．01）。结论急诊PCI较尿激酶静脉溶栓及单纯药物治疗急性心肌梗死更能充分开通IRA，改善心功能，减少临床事件，缩短住院天数，可进一步降低高危急性心肌梗死病死率。Objective To determine the influence on 28 - day mortality for higher risk acute myocardial infarction（AMI） by primary PCI. Methods Six hundred and thirty -seven patients with ST segment elevation AMI, less than 12 hours onset were divided into three groups： primary PCI group; thrombolytic group;medical group. Based on P value of multivariate logistic regression analysis for higher risk AMI,three groups were divided into higher risk and lower risk subgroups. Primary PCI groups received acute coronary angiography, open, thrombolysis, slow reflow and no - reflow of IRA were evaluated by Timi flow grade ; Clinic events in hospital were recorded ; LVEF was measured with two - dimensional echocardiography after 4 weeks onset. Results The open rate was 100.00% in primary PCI group and 99.00% in stent rate. The coronary thrombolysis rate in operation is respectively 25.03% , 20. 31% in higher risk subgroup and lower risk subgroup （ P 〉 0.05 ） , and the slow reflow rate was respectively 25.27% , 30.12% （ P 〉0.05）. And the no - reflow rate were respectively 4.00% , 0. 00% （ P all 〉 0.05）. The clinical events including hemorrhage frequency： there were no difference in statistics among three groups and subgroups; Heart failure frequency： medical group and subgroup were higher than an- other two groups and subgroups（ P 〈0.01） ; Angina pectoris frequency; Reocclusion frequency： throm- bolytic group and subgroup were higher than another two groups and subgroups（ P 〈0. 05 orP 〈0.01 ）. The days in hospital obviously reduce in primary PCI group and subgroup （ P 〈 0. 05 or P 〈 0.01 ）. LVEF： medical group and subgroup were lower than another two groups and subgroups （ P all 〈 0.05）. The mortality were respectively 0% , 7.46% , 18.72% for three groups （ P 〈0. 05 orP 〈0. O1 ） ;is re-spectively 0%, 10. 45% , 26. 03% for three higher risk subgroups （P 〈 0.05 or P 〈 O. O1 ）. Conclusions Primary PCI in AMIcould improve the reperfusion of IRA and left ventricular

关 键 词：急性心肌梗死 高危因素 尿激酶 支架 近期病死率 

分 类 号：R542.22[医药卫生—心血管疾病]