溶栓后联合介入治疗对急性心肌梗死患者心肌组织灌注的影响

Study of facilitated percutaneous coronary intervention on the myocardial perfusion in patients with acute myocardial infarction

目的:探讨溶栓后联合经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心肌组织灌注的影响。方法:采用回顾性分析首次AMI患者94例,发病时间均在12 h以内。36例接受溶栓联合PCI治疗,58例接受直接PCI治疗,并于PCI后测定心肌组织灌注分级,了解二者对AMI患者心肌组织灌注的影响。结果:2组患者自发病至PCI时间比较无明显差异;首次冠状动脉造影显示:溶栓联合PCI组PCI前梗死相关动脉TIMI 3 级血流者明显较直接PCI组增多;溶栓联合PCI组介入治疗成功率高,且术后TIMI 3级血流者、PCI后心肌组织灌注TMP 2级以上者均明显多于直接PCI组;2组比较出血并发症发生率无明显差异。结论:溶栓联合PCI治疗AMI安全有效,早期再通率高,心肌微循环灌注好,心肌梗死面积小,更有利于保护心室功能,且不增加出血并发症。

Objective：To explore the effect of facilitated percutaneous coronary intervention （PCI） on the myo cardial perfusion in the patients with acute myocardial infarction（AMI）. Method： A total of 94 patients with AMI were involved in the study, which 36 patients received facilitated PCI and 58 patients received primary PCI group. After PCI, the myocardial perfusion grade were measured by coronary angiography with TMP grades. Result： There was no significant difference about the mean interval from onset to the PCI between group A and group B. At the first CAG the patients with TIMI 3 flow were more in the facilitated PCI group;the procedural success rate was higher and patients with TIMI 3 flow after PCI were more in the facilitated PCI group;and the myocardial perfusion was better in the facilitated PCI group;the bleeding complications were similar in two groups. Conclusion： Facilitated PCI was safe and effective for AMI, with a higher early patency rate, better myocardial perfusion, smaller myocardial infarction area, better heart function, and without increased bleeding complications.