静脉溶栓后介入疗法与直接介入疗法治疗老年人急性心肌梗死的疗效比较  

Comparison of the effects of interventional therapy and direct interventional therapy after thrombolysis in the treatment of elderly patients with acute myocardial infarction

作　　者：曾小康[1] Zeng Xiaokang(Department of ICU, the First People′s Hospital of Hangzhou, Hangzhou, Zhejiang 310006, China)

机构地区：[1]杭州市第一人民医院ICU,310006

出　　处：《中国基层医药》2019年第5期552-555,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较静脉溶栓后介入疗法与直接介入疗法治疗老年人急性心肌梗死的疗效及安全性。方法选取2014年1月至2017年7月杭州市第一人民医院收治的110例老年急性心肌梗死患者作为研究对象,采用随机数字表法分为观察组(55例,采用静脉溶栓后联合冠状动脉介入治疗)和对照组(55例,采用直接冠状动脉介入治疗)。比较两组治疗前后的IRA血流、达TIMI3级开通情况、心功能改善情况[包括左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)],以及治疗后的心电图检测ST段下移、胸痛缓解、支架植入成功与否、并发症发生情况。结果治疗前,两组IRA达TIMI3级血流开通例数(10例、15例)、TIMI3级开通例数(12例、18例)差异无统计学意义(P>0.05);治疗后,观察组分别增加到50例、51例,对照组仅增加到39例、40例,观察组人数增加更明显(χ^2=7.698,P<0.05)。治疗后,两组的LVEF值有所升高,LVEDD明显降低,观察组的LVEF(57.38±4.23)%、LVEDD(44.32±2.93)mm较对照组的LVEF(51.07±4.17)%、LVEDD(50.09±2.97)mm,改善更明显(t=7.878、10.257,均P<0.05),观察组治疗后心电图检测ST段下移发生率(92.73)%、胸痛缓解率(90.91)%均高于对照组的ST段下移发生率(65.45)%、胸痛缓解率(61.82)%(χ^2=12.369、12.894、2.633,均P<0.05),观察组的并发症总发生率9.09%,低于对照组的29.09%,差异有统计学意义(χ^2=7.122,P<0.05)。结论溶栓后介入疗法治疗老年急性心肌梗死,能有效改善患者心功能,疗效显著,安全可靠,值得进一步研究。Objective To compare the efficacy and safety of interventional therapy and direct interventional therapy after thrombolysis in the treatment of senile acute myocardial infarction. Methods From January 2014 to July 2017, a total of 110 elderly patients with acute myocardial infarction admitted to the First People′s Hospital of Hangzhou were enrolled in this study.The patients were randomly divided into two groups according to the digital table, with 55 cases in each group.The observation group received combination of intravenous thrombolysis and coronary intervention, and the control group received arterial intervention.The blood flow of IRA before and after treatment, TIMI level 3 open situation, cardiac function improvement(including LVEF, LVEDD), and electrocardiogram ST segment down after treatment, chest pain relief, stent implantation success or failure, incidence of complications were compared between the two groups. Results Before treatment, there were no statistically significant differences in the number of TIMI3 blood flow patients(10 cases, 15 cases) and number of TIMI3 patients (12 cases, 18 cases) between the two groups(P>0.05). After treatment, those in the observation group increased to 50 cases and 51 cases, respectively.Those in the control group only increased to 39 cases and 40 cases.The observation group increased more significantly(χ^2=7.698, P<0.05). After treatment, the LVEF values of the two groups were increased, the LVEDD decreased significantly.The LVEF[(57.38±4.23)%]and LVEDD[(44.32±2.93)mm]in the observation group were improved more significantly than those in the control group[(51.07±4.17)%,(50.09±2.97)mm, t=7.878, 10.257, all P<0.05]. The incidence rate of ST segment depression(92.73%) and chest pain relief rate(90.91%) in the observation group after treatment were higher than those in the control group(65.45%, 61.82%,χ^2=12.369, 12.894, 2.633, all P<0.05). The total incidence rate of complications of the observation group was 9.09%, which was lower than that of the control

关 键 词：心肌梗死 经皮冠状动脉介入疗法 血栓溶解疗法 心肌再灌注 老年人 

分 类 号：R542.22[医药卫生—心血管疾病]