早期再灌注治疗急性心肌梗塞的临床效果

The effect of early reperfusion on clinical outcome of acute myocardial infarction

比较梗塞相关动脉早期开放和闭塞对急性心肌梗塞临床过程的影响。结果表明，急性心肌梗塞后早期再灌注可缩小梗塞面积，改善左室射血功能，降低病死率。溶栓后补救性ＰＴＣＡ再通率高，对大面积心肌梗塞伴有低血压和心源性休克的患者有明显效果。

Abstract The study is designed to investigate the effect of early reperfusion on clinical outcomes of acute myocardial infarction (AMI). Patients (Pts) with AMI were treated with thrombolytic agents (defibrase, urokinase,streptokinase or r-tPA) or PTCA if thrombolysis failed to achieve recanalization. Coronary arteriography was performed before or/and within 90 min of thrombolysis.Serum CPK were measured serially and LVEF by nuclear blcod pool scan was determined before discharge. The severity of the clinical course was graded by a score system. Patency of the infarct-related arteries (IRA) were demonstrated in 34 pts and occluded IRA in 14 pts. There was no death in pts with patent IRAs while 5 deaths occured in pts with occluded IRAs. In pts with patent IRAs the clinical outcome improved.The clinical score rose from 5.10±0.29 to 5.9±0.094. LVEF was 0.53±0.014. In pts with occluded IRAs the clinical course deteriorated. The score decreased from 5.40±0.40 to 3.8±0.61, LVEF 0.43±0.021. The differences between the two groups were statistically significant. In conlusion, early reperfusion improves LVEF and reduces mortality. PTCA achieves prompt recanalization, and is life-saving for pts with hypotension and cardiogenic shock.