急性ST段抬高性心肌梗死不同再灌注方法的分析

Analysis of different reperfusion methods for acute ST segment elevation myocardial infarction

目的探讨急性ST段抬高性心肌梗死(STEMI)不同再灌注治疗方法的意义和可行性。方法回顾性分析北大深圳医院271例初发STEMI病人的心电图、心脏超声和造影资料。直接经皮冠状动脉介入的(PCI)STEMI病人31例,静脉溶栓病人44例,其中溶栓联合PCI26例,补救性介入治疗PCI病人18例。结果直接PCI、溶栓联合PCI和补救性PCI的STEMI病人年龄、性别、糖尿病、高血压、高血脂、吸烟、症状开始至治疗的时间、侧支循环和TIMI血流0级无显著性差异(P>0.05)。住院期间不稳定性心绞痛、再梗死、脑卒中、心功能不全和复杂室性心律失常的发生无显著性差异(P>0.05)。Killip心功能分级、Q波计数和室壁运动积分、射血分数(LVEF)、心指数(CI)、每搏指数无显著性差异(P>0.05)。结论STEMI溶栓联合PCI干预可能是一种安全有效的治疗方法,补救性PCI可能有利于左室功能的恢复。

Objective To evaluate significance of different reperfusion methods in the treatment of acute ST segment elevation myocardial infarction （STEMI）. Methods A retrospective analysis of the clinical data of electocardiography （ECG）, echocardiogram, and angiography was conducted in 271 cases of STEMI treated in our hospital. Of these patients 31 were treated by primary percutaneous coronary intervention （PCI）, and 44 by intravenous thrombolysis with urokinase, including 26 with thrombolytic treatment with concomitant PCI and 18 with rescue PCI. Results The patients receiving primary PCI, thrombolytic therapy along with PCI, and rescue PCI did not exhibit significant differences in age, sex, diabetes, hypertention, hyperlipidemia, smoking status, symptom onset to treatment time, or collateral circulation （P〉0.05）. The incidence of cardiac events including unstable angina, complex ventricular arrhythmia, and cardiac insufficiency were not significantly different between the 3 groups （P〉0.05）, nor was Killip class, number of Q waves on ECG, wall motion score, left ventricular ejection fraction, cardiac index, or stroke volume index （P〉0.05）. Conclusion Combination of thrombolytic therapy and interventional therapy can be a safe and effective treatment of STEMI, and rescue PCI may benefit the improvement of the left ventricular function.