急诊直接冠脉介入治疗急性心肌梗塞的临床价值

Clinical benefits of immediate percutaneous coronary intervention therapy in patients with acute myocardial infarction

目的：探讨急诊直接经皮冠状动脉介入治疗（PCI）对急性心肌梗塞（AMI）患者近期及远期预后的影响。方法：65例初次AMI患者被随机分为两组：直接PCI组（A组，35例）及静脉溶栓成功组（B组，30例）。比较分析住院及随访期间两组主要临床事件发生率。结果：（1）住院期间直接PCI组的平均住院天数（d）、出血率（％）、再发不稳定心绞痛（％）、非致死心肌梗塞（％）、心源性死亡率（％）明显低于溶栓组（P〈0.01）；（2）随访期直接PCI组左室扩大（％）、室壁瘤形成（％）、死亡（％）、再狭窄率（％）等发生率亦显著低于溶栓组（P〈0.01）．存活率（％）及射血分数（％）明显高于溶栓组（P〈0.05-〈0．01）。结论：急诊直接PCI治疗是早期再灌注安全有效的方法，对于提高再通率、减少并发症及改善心功能优于溶栓组。

Objective： To compare the short and long term clinical prognoses of immediate percutaneous coronary intervention （PCI）, and intravenous thrombolytical （IT） therapy in patients with acute myocardial infarction （AMI）. Methods： A total of AMI 65 patients were divided into immediate PCI group （group A, 35 cases）, IT therapy group （group B, 30 cases）. Results： （1） The in-hospital cardiac events of immediate PCI group were less than those of IT group （P〈0. 01） ; （2） During follow- up period, the occurrence rates of cardiac events and cardiac death in immediate PCI group were less than those of IT group; the restenosis rate of infarct related artery in PCI group was less than that in IT group; the survival rate and LVEF in PCI group were higher than those in IT group （P〈0.05-〈0, 01）, Conclusion： Immediate PCI possesses a better outcome of improving short and long term clinical prognoscs than IT therapy for AMI patients,