急性心肌梗塞的抢救与急诊治疗方式的探讨

Prehospital and Emergency Treatment of Acute Myocardial Infarction

目的对本院急性心肌梗塞(AcuteMyocardialInfarction,AMI)患者的抢救与急诊治疗方式进行总结,以确定院前急救的重要性,并且评价了急诊冠状动脉介入(PercutaneousCoronaryIntervention,PCI)与溶栓治疗各自的疗效。方法施行院前急救措施以后,对104例AMI患者的急诊治疗情况和死亡率,与本院以前的病例进行对比。对其中的72例患者行急诊PCI治疗(PCI组),运用PTCA(PercutaneousTransluminalCoronanryAngioplasty)和支架置入术;32例患者行溶栓治疗(溶栓组),比较两组患者住院和随访期间的状况。结果对AMI患者施行院前急救措施之后,死亡率下降2.1%,住院天数明显减少,各项指标均有显著者性差异(P<0.05)。其中PCI组住院期间死亡4例,抢救成功率为94.4%,左室射血分数(LeftVentricularEjectionFraction,LVEF)为54.6±4.7%;随访6个月,心绞痛发作4例,3例择期再次PTCA。溶栓组住院期间死亡5例,抢救成功率为84.4%,LVEF为46.3%±4.8%,随访6个月,心绞痛发作10例,8例行择期PTCA。结论院前急救非常有效的提高了AMI急诊的抢救成功率,并且有利于患者的及早康复。AMI急诊PCI治疗可以及时开通被梗塞的血管(InfarctRelatedArteries,IRA),与溶栓治疗相比,可以显著降低AMI的死亡率(P<0.01),并且有效的保护心脏功能,改善AMI患者的预后状况。

Objective To determine the necessity of local first aid for the patients with AMI and to compare the outcome of PTCA and thrombolytic therapy. Methods After performance of local first aid for the patients with AMI, the results of emergency treatment and ratio of death were compared to those of before. Seventy-two cases received emergency PCI therapy and 32 received thmmbolytic therapy. Results Applying first aid for the patients with AMI led to 2.1% decrease of death ratio and also significant decrease of hospitalization period （P〈0.05）. Four cases were dead in PCI group and the ratio of successful rescue was 94.4% with the mean LVEF of 54.6%-4-4.7%. In the following 6 months there were 4 cases of angina pectnris and 3 of them received the PTCA treatment again. Five cases were dead in thmmbolytic therapy group and the ratio of successful rescue was 84.4% with the mean LVEF of 46.3%-4-4.8%. In the following 6 months, there were 10 cases of angina pectoris and 8 of them received the PTCA treatment. Conclusions First aid for the patients with AMI may increase the ratio of successful rescue and decrease the duration of hospitalization. The infarct related arteries can be revascularized with emergency PTCA treatment, which reduces the death ratio of patients with AMI and makes prognosis better in comparison with the thmmbolytic therapy group.