急性心肌梗死优化介入治疗的临床研究

Comparison of emergency percutaneous coronary intervention and intravenous thrombolysis combined with emergency percutaneous coronary intervent for acute myocardial infarction

目的探讨经皮冠状动脉介入治疗(PCI)联合尿激酶静脉溶栓(即优化介入治疗)治疗急性心肌梗死(AMI)的有效性和安全性。方法128例发病时间≤12 h的首次AMI患者随机分为溶栓治疗+PCI组(74例)和直接PCI组(54例),对两组患者介入治疗前梗死相关血管(IRA)通畅率、介入治疗成功率、出血并发症发生率、住院期间急性心脏缺血事件发生率及出院前左心室功能(LVEF)进行比较。结果冠状动脉介入治疗前溶栓治疗+PCI组IRA通畅率(65.7%)显著高于直接PCI组(24.3%)(P<0.05),前者介入治疗成功率为100%;两组IRA通畅率分别为96.9%和94.6%;住院期间两组均无严重出血及急性心脏缺血事件发生;出院前经超声心动图测得LVEF在溶栓治疗+PCI组为64.8%,明显高于直接PCI组的57.5%(P<0.05)。结论静脉溶栓联合PCI治疗AMI早期再通率高,更有利于保护左室功能,不增加出血并发症。

Objective To evaluate the efficacy and safety of intravenous thrombolysiswith urokinase combined with emergency interventional therapy acute myocardial infarction（AMI）. Methods 128 patients with AMI were randomized to thrombolysis plus PCI group and primary PCI group, the patency rate of infarct related artery （IRA） before intervention, the procedural success rate, the incidence of bleeding complications and acute ischemic events during hospitalization and the left ventricular ejection function（LVEF） measured by echocardiography before discharge were compared. Results The IRA patency rate in the thombolysis plus PCI group（65.7 % ） was significantly higher than that in the primary PCI group（24.3 % ） （ P 〈 0.05）, the procedural success rate of the former was 100% ,no major bleeding complication and acute isehemic event occurred during hospitalization in both groups, the LVEF in the thrombolysis plus PCI group（64.8 % ） was higher than that in the primary PCI group（57.5 % ） before discharge （ P 〈 0.05 ）. Conclusion Intravenous thrombolysis with urokinase combined with emergency interventional therapy for AMI is safe and effective with a higher early patency rate, better cardiac functionand no major bleeding complications.