急性心肌梗死急诊介入治疗与溶栓治疗的疗效比较

Comparison of the clinical efficacy of primary percutaneous coronary intervention with thrombolytic therapy for acute myocardial infarction

目的比较急性ST段抬高性心肌梗死(STEMI)患者分别接受直接经皮冠状动脉介入(PCI)治疗和溶栓治疗住院及随访期间的临床疗效差别。方法108例STEMI患者,66例行直接PCI治疗(PCI组),42例行溶栓治疗(UK组)。比较2组梗死相关动脉(IRA)再通率、左室功能指标、病死率及主要心血管事件发生率的差别。结果PCI组IRA开通率高于UK组(P<0.01),住院病死率低于UK组(P<0.05),左室功能指标优于UK组(左室射血分数更高、左室舒张末径较小、室壁运动障碍率较低,P<0.05)。随访期间比较PCI组再次血运重建率低于UK组(P<0.01),心血管病死率低于UK组(P<0.05)。结论与溶栓治疗相比,PCI治疗能及时有效地开通梗死相关血管,改善左室功能,降低病死率和再次血运重建率。

Objective To compare the clinical efficacy of primary percutaneous coronary interventions（PCI） with that of thrombolytic therapy for acute ST segment elevated myocardial infarction （STEMI） patients. Methods TotaIIy, 108 STEMI patients were enrolled, 66 patients underwent primary PCI （PCI group）, and 42 patients were treated with thrombolytic drug： urokinase therapy （ UK group）. The recanalizing rate of IRA, mortality, left ventricular function and major cardiac events rate between the two groups of patients were compared. Results Clinical outcomes during hospitalization ： In PCI group, the recanalizing rate of IRA was higher（P 〈0. 01 ） ,in-hospital mortality was lower（P 〈0. 05） ,indexes of left ventricular function were better. Major cardiac event rates during follow-up： The rates of accumulative cardiac mortality （ P 〈 0. 05 ） and revascularization （ P 〈 0. 01 ） were lower in PCI group. Conclusions Compared to the thrombolytic therapy, primary PCI could more rapidly and efficaciously restore the blood flow in IRA, reduce in hospital mortality of AMI, improve left ventricular systolic function, decrease revascularization possibility of IRA and mortality during follow-up.