急诊直接介入治疗和急诊溶栓后介入治疗对急性心肌梗死预后的影响  

A comparative study of the effects of emergency direct interventional therapy and emergency post-thrombolytic interventional therapy on acute myocardial infarction

作　　者：任娟 王怀新[2] REN Juan;WANG Huaixin(Department Internal Medicine,Weifang Medical University,Weifang 261053,China;Department of Emergency,Weifang Yidu Central Hospital)

机构地区：[1]潍坊医学院内科学教研室,山东潍坊261053 [2]潍坊市益都中心医院急诊科

出　　处：《潍坊医学院学报》2019年第5期331-333,共3页Acta Academiae Medicinae Weifang

摘　　要：目的比较S-T段抬高型急性心肌梗死(STEMI)急诊直接经皮冠状动脉介入治疗(PCI)与溶栓后延迟的PCI治疗对STEMI预后的影响。方法对入选的170例STEMI患者随机分为直接PCI组(85例)和溶栓治疗后延迟PCI组(85例)。对比观察两组患者在住院期间和出院后1年内发生的全因死亡、心脏性死亡、非致死性心肌梗死、严重心肌缺血发生及心功能NYHAⅣ级的发生率。结果直接PCI组住院期间全因死亡及心脏性死亡发生率与延迟PCI组比较有统计学意义(2.24%vs 12.05%,P=0.03;1.23%vs 7.06%,P=0.03),严重心绞痛的发病率也有统计学差异(0 vs 7.23%,P=0.02)。出院1年内全因死亡两组间差异无显著性,但心脏性死亡两组比较,差异有显著性(1.23%vs 8.43%,P=0.03)。1年内NYHAⅣ级发生率有统计学差异(3.70%vs 14.46%,P=0.03),而1年内严重心肌缺血发生率及非致死性心肌梗死的发生率,两组比较无统计学意义(P>0.05)。以直接PCI为变量,对心脏事件的影响进行Logistic回归分析,结果其OR值为0.38,95%CI:0.19~0.58,P=0.01。结论 STEMI急诊直接PCI优于延迟的PCI,应作为STEMI的首选治疗方法。Objective To evaluate the effects on prognosis of emergency percutaneous coronary intervention(PCI) and delayed PCI after thrombolysis on ST-segment elevation acute myocardial infarction(STEMI).Methods One hundred and seventy patients with STEMI enrolled were randomly divided into two groups:primary coronary intervention(PCI) group(85 cases) and delayed PCI group(85 cases),and the incidence of all-cause mortality,cardiac death,no-fatal myocardial infarction,severe myocardial ischemia and grade Ⅳ of NYHA were compared between the hospitalized and the patients within one-year after discharge.Results During hospitalization,there were significant differences between two groups in the all-cause mortality and cardiac death(2.24% vs 12.05%,P=0.03;1.23% vs 7.06%,P=0.03,respectively),as well as the occurrence rate on severe angina between two groups(0 vs 7.23%,P=0.02).However,for patients discharged within one year,no significant differences were found in all-cause mortality(6.17% vs 10.84%,P=0.56),but were found in cardiac death(1.23% vs 8.43%,P=0.03).The occurrence rate of NYHA IV within 1 year was statistically different(3.70% vs 14.46%,P=0.03),instead,no significant differences on incidence rates were found between severe myocardial ischemia and nonfatal myocardial infarction(P>0.05).If primary PCI served as a variable for cardiac events,the results of Logistic regression showed that odds ratio(OR) value was 0.38;95% confidence interval(CI):0.19~0.58,P=0.01.Conclusion The primary coronary intervention is better than delayed PCI,and should be the first choice for STEMI patients.

关 键 词：ST段抬高型急性心肌梗死 心脏介入治疗 溶栓治疗 

分 类 号：R542.22[医药卫生—心血管疾病]