STEMI病人rt-PA溶栓后即刻介入治疗的安全性及效果  

THE SAFETY AND EFFICACY OF IMMEDIATE PERCUTANEOUS CORONARY INTERVENTION AFTER THROMBOLYSIS WITH rt-PA FOR ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

作　　者：刘青青[1] 修振顺[1] 周长勇[2] 李中昕[1] 

机构地区：[1]即墨市人民医院心内科,山东即墨266200 [2]青岛大学医学院附属医院急诊内科

出　　处：《齐鲁医学杂志》2012年第2期177-178,180,共3页Medical Journal of Qilu

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)病人应用重组组织型纤溶酶原激活剂(rt-PA)溶栓后即刻介入治疗的安全性及效果。方法急性STEMI病人98例,随机分为溶栓后即刻介入治疗组(A组)及溶栓后保守治疗组(B组)。应用rt-PA溶栓后,A组病人即刻行冠状动脉造影,必要时行支架置入术;B组病人则采用基本药物治疗。观察并记录两组住院期间死亡及出血等并发症的发生情况,术后1周心功能情况及出院后6个月不良事件发生情况。结果两组病人院内死亡及出血并发症发生率差异无统计学意义(χ2=0.29、0.16,P>0.05)。住院1周,A组左心室舒张末内径小于B组,左心室射血分数高于B组,血清B型利钠肽(BNP)水平低于B组,差异有统计学意义(t=5.00～5.94,P<0.05)。随访6个月,A组心脏性死亡及复合终点事件发生率低于B组,差异有统计学意义(χ2=4.11～5.03,P<0.05)。结论急性STEMI病人rt-PA溶栓后即刻介入治疗是安全的,且对病人的心功能及预后均有益。Objective To investigate the safety and efficacy of immediate post-thrombolysis percutaneous coronary intervention（PCI） in the treatment of patients with ST-segment elevation acute myocardial infarction（STSEAMI）. Methods Ninety-eight patients with STSEAMI were randomized to group A（immediate PCI after thrombolysis） and group B（expectant treatment after thrombolysis）.After thrombolysis by using rt-PA,the patients in group A received immediate coronary angiography,and a stent placement when needed;those in group B received pharmacotherapy.Death and bleeding of all patients during hospital stay,heart function one week after the procedure,and adverse events six months post-discharge were observed and recorded. Results The differences between the two groups were not statistically significant in terms of in-hospital death and bleeding（χ2=0.29,0.16;P〈0.05）.During one-week hospitalization,the left ventricular end-systolic diameter（LVED） was smaller,left ventricular ejection fraction（LVEF） was higher,and B-type natriuretic peptide（BNP） concentration was lower in group A than that in group B,the differences were significant（t=5.00-5.94,P〈0.05）,A follow-up of six months showed the rate of cardiac death and major adverse events were lower in group A versus group B（χ2=4.11-5.03,P〈0.05）. Conclusion Immediate post-thrombolysis PCI is safe and beneficial to heart function and prognosis of patients with STSEAMI.

关 键 词：心肌梗死 血栓溶解疗法 PCI 心室功能 预后 

分 类 号：R542.22[医药卫生—心血管疾病]