不同方式再通梗死相关血管对急性心肌梗死面积及近期预后的影响(英文)  

Effect of patency on infarct size and short term prognosis in patients with acute myocardial infarction by intravenous thrombolysis or PTCA

作　　者：游斌权[1] 米世簪[2] 苏唏[1] 

机构地区：[1]武汉亚洲心脏病医院,湖北武汉430022 [2]华中科技大学同济医学院附属同济医院,湖北武汉430030

出　　处：《中国现代医学杂志》2004年第3期7-10,共4页China Journal of Modern Medicine

摘　　要：目的　探讨急性心肌梗死 (AMI)急诊经皮冠状动脉腔内成形术 (PTCA)与静脉溶栓治疗后梗死相关血管 (IRA)再通对心肌梗死面积 (MIS)及近期预后的影响。方法　 5 5例AMI患者中 ,19例行急诊PTCA+支架植入术 ,36例静脉溶栓开通IRA ,应用ST段运算法和QRS记分法预计IRA再通前及再通 2周后MIS ,并对其住院期间并发症和死亡率进行分析。结果　PCTA组和静脉溶栓组的IRA再通前MIS %分别为(2 4 .13± 5 .6 5 ) ,(2 3.80± 5 .74 ) ,两组无明显差别 (P >0 .0 5 )。IRA再通后 ,PTCA组实际梗死区心肌存活率可达 (32 .4 2± 8.5 9) % ,较溶栓组的 (2 0 .0 2± 10 .12 ) %要高 (P <0 .0 5 )。PTCA组和静脉溶栓组的住院期间严重的心功能不全、梗死后心绞痛、出院时IVEF等有显著性差异 ,而死亡率、恶性心律失常发生率在两组无显著性差异。结论　直接PTCA较静脉溶栓治疗再通后可挽救较多处于梗死边缘的心肌 ;PTCA组近期并发症发生率低于静脉溶栓组。Objective: The purpose of this study was to evaluate the effect of patency of infarction-related coronary artery (IRA) on infarct size and the short term prognosis in acute myocardial infarction (AMI) patients treated with intravenous thrombolytic therapy or primary transluminal coronary angioplasty (PTCA).Methods:55 consecutive patients with acute myocardial infarction were studied. The IRA was reperfused by PTCA together with direct introcoronary stent in 19 patients (PTCA group) and by intravenous thrombolysis in 36 patients(thrombolytic group). ST segment algorithm method and ORS scores were used to predict infarct size. The clinical complications and mortality rate during hospitalization were also analyzed.Results:The predict means of infarct size(%) in the PTCA group and Thrombolytic group were (24.13±5.65) and (23.80±5.74), respectively, before patency. There was no significant diffrence between them,Infarct size was significant reduced in PTCA group than in Thrombolytic group 2 weeks after patency [(32.42± 8.59) % vs ( 20.02±10.12)%, P<0.05]. Severe pump failure and postinfarction angina pectoris were reduced in PTCA group, and left ventricular ejection fraction were significantly improved in PTCA group than in Thrombolytic group (P<0.05), but no significant difference in malignant arrhythmia and mortality were found between two groups (P>0.05).Conclusions:Patency of IRA by PTCA can significantly reduce infarction size than by intravenous thrombolysis. PTCA can significantly reduce the clinical complications and improve hospitalization prognosis.

关 键 词：急性心肌梗死 直接经皮冠状动脉腔内成形术 静脉溶栓 梗死相关血管 心电图 

分 类 号：R542.22[医药卫生—心血管疾病]