经皮冠状动脉介入治疗急性心肌梗死伴心力衰竭、心源性休克的疗效分析

Study on clinical outcome of PCI for AMI with heart failure or cardiogenic shock

目的观察ST段抬高的急性心肌梗死(AMI)伴心力衰竭(心衰)、心源性休克患者经皮冠状动脉介入(PCI)治疗的近期和中期疗效。方法206例ST抬高AMI患者,伴心衰和(或)休克90例。对心衰和(或)心源性休克患者行PCI58例、药物溶栓20例、一般治疗12例(未行再灌注组);比较PCI组和溶栓组的住院时间、住院及随访期间不良心血管事件发生率、心功能恢复情况,观察PCI组血管开通时间、TIMI血流与预后的关系。结果PCI组、溶栓组血管开通率分别为98.3%和65.0%(P<0.01),平均住院时间分别为15.3天±3.5天和20.5天±4.4天,住院及随访期间死亡率PCI组6.9%,溶栓组25%(P<0.05)。PCI组两亚组术后心功能恢复均好于溶栓组(P<0.01和P<0.05)。结论PCI与溶栓相比,能及时开通血管且开通率高,术后心功能恢复较好,安全有效,可作为首选。

Objective To observe the short and middle-term effects of percutaneous coronary intervention （PCI） on patients with ST-segment elevation acute myocardial infarction（AMI） complicated by heart failure or cardiogenic shock. Methods 90 cases with AMI were recruited, of which 58 cases were treated by PCI and 20 cases were treated by thrombolysis respectively, however, no rcperfusion therapy was performed in another 12 cases. Lenth of hospital stay ,major adverse cardiac event and left ventricular ejection fraction（LVEF） were compared in PCI and thrombolysis groups. The relationship between patency time of infarcted related artery （IRA） ,TIMI grade after PCI and prognosis were analysed in PCI group. Results The patency rates of IRA was significantly improved in patients receiving PCI therapy （ P 〈 0.01 ）. Compared with thrombolysis group,the LVEF was also higher in PCI group and mortality was much lower during in-hospital and follow-up period. Conclusion Compared with thrombolysis, PCI was a more effective therapy to treat ST-segment elevation AMI companied with heart failure or cardiogenic shock.