急性心肌梗死介入治疗与溶栓治疗的疗效比较

Effection of Percutaneous Coronary Intenvention Compared with Intravenous Thrombolysis Therapy of Acute Myocardial Infarction

目的对比急性心肌梗死成功介入治疗及成功溶栓治疗的近期疗效和远期疗效。方法共纳入56例首发心梗患者,既往无心衰病史。随机分别接受介入治疗或溶栓治疗,均治疗成功。并在入院7.5±0.4 d时行超声心动图检查。并随访其心源性死亡事件的发生。结果介入治疗组有27例和溶栓治疗组有29例,在入院7.5±0.4 d时行超声心动图检查,左室射血分数(LVEF)介入组为(57.6±2.3)%,溶栓组为(49.9±1.9)%相比较有显著差异(P<0.01)。但左室舒张末内径(LVEDD)介入组为53.42±6.28 mm,溶栓组为53.18±5.69 mm相比较无显著差异(P<0.5)。在进行了平均为期548.7±48.9 d随访后发现介入组生存率为85.2%,溶栓组生存率为79.3%(P<0.5),两组的生存率分布无显著差异。结论在轻中度的急性心梗患者中,使用了普通支架的介入治疗改善急性心肌梗死后近期内的心功能明显优于溶栓治疗;但对于急性心肌梗死后的长期预后则可能无明显的优势。

Objective To evaluate the curative effect of the two successful therapeatic methods on myocardial infarction in the acute and long-term stage ： percutaneous coronary intenvention（PCI） and intravenous thrombolysis therapy. Methods Fifty-six patients of acute myocardial infarction were studied. There was no record of heart failure occurence in the case history for all of them. We randomly assigned them to receive PCI or intravenous thrombolysis therapy, and all of them are treated successfully. Left ventricule ejection fraction （LVEF） and left ventricule end diastole diameter（LVEDD） measured by echocardiography were analyzed. Clinical information about death caused by cardial origin problems were collected and the mean survival days of the patients were 548.7 ± 48.9. Results The total of 27 patients were assigned to undergo PCI and 29 patients received intravenous thrombolysis therapy. LVEF patients with PCI were 57.6 % ± 2.3 % , and patients with intravenous thrombolysis therapy were 49.9 % ±1.9 %. There were significant difference between the two groups（P 〈 0.01）. LVEDD patients with PCI were 53.42 ±6.28 mm, and patients with intravenous thrombolysis therapy were 53.18±5.69 mm, and there were no significant difference between the two groups（P 〉0. 5）. 548.7±48.9 days survival was accounted for 85.2 % in the PCI group, and 79.3 % in the intravenous thrombolysis therapy（ P 〉 0.5）. Multivariate analysis showed that older age, LVEF, were related to 548.7± 48.9 days mortality. Conclusion The results of this study show more acute stage benefit patients treated with PCI using bare stant than those treated with intravenous thrombolysis therapy; But it indicates that there is no more long-term survival for patients treated with PCI by using bare stant compared with those who received intravenous thrombolysis therapy in the patients with light or medium acute myocardial infarction.