老年急性下壁心肌梗死溶栓后冠状动脉介入治疗安全性研究

Safety of coronary artery intervention for elderly patients with acute inferior myocardial infarction after thrombolytic therapy

目的探讨老年急性下壁心肌梗死急诊溶栓后经皮冠状动脉介入治疗的有效性和安全性。方法对由外院首诊后转运接受溶栓治疗的50例老年急性下壁心肌梗死患者按简单随机化分为两组,每组25例。对照组患者使用常规药物(阿司匹林300mg,氯吡格雷300mg)后直接行经皮冠状动脉介入治疗,研究组患者使用尿激酶150万U,再行急诊经皮冠状动脉介入治疗。观察患者胸痛缓解情况及动脉开通率,术后并发症发生率。结果所有接受治疗的老年急性下壁心肌梗死的患者均成功行血运重建,研究组患者来院后胸痛缓解率为80.0%,对照组为40.0%;研究组患者梗死相关动脉总开通率达88.0%,对照组为32.0%;研究组术后并发症主要有心律失常,严重出血,一过性窦性心动过缓、房室传导阻滞及低血压,经药物治疗后可恢复。结论需要急诊转运的老年急性下壁心肌梗死患者,在溶栓后转运再行急诊血运重建治疗的临床疗效及安全性较好,可考虑作为基层医院转运急性心肌梗死患者的首选处理方法。

Objective To evaluate the efficacy and safety of percutaneous coronary intervention for elderly patients with acute inferior myocardial infarction after thrombolytic therapy. Methods Fifty patients with acute inferior myocardial in- farction were enrolled from April 2012 to April 2014 and randomized into two groups： 25 patients in control group received o- ral administration of aspirin 300rag and clopidogrel 300rag followed by percutaneous coronary intervention; 25 patients in test group underwent percutaneous coronary intervention in emergency after thrombolysis with urokinase 1.5 million units. Results Vessel reconstruction was successfully achieved in all patients. Chestpain release rate was 80% in test group and 40% in the control group. The rate of opening-up of the obstructive artery was 32% in control group, while the rate was 88% in test group （P〈0.05）. The postoperative complications were arrhythmia, severe bleeding, sinus tachycardia, atrioventricular block and hy- potension, which were recovered after drug therapy. Conclusion Vessel reconstruction following thrombolysis for the elders with acute inferior myocardial infarction in emergency is effective and safe, and is recommended as the first treatment for patients re- ferred from community hospitals after thrombolysis.