急性心肌梗死患者超早期溶栓治疗后发生心力衰竭的随访观察

Reduction of congestive heart failure symptoms by very early fibrinolytic therapy in acute myocardial infarction:A long-term follow-up

目的随访观察急性心肌梗死（AMI）患者超早期溶栓治疗对减少心力衰竭发生的影响。方法连续358例应用尿激酶溶栓的AMI患者,161例胸痛后〈1.5 h溶栓,其中68例院前溶栓,为A组;197例胸痛后1.5-4 h溶栓为B组。随访2年,观察和记录心力衰竭的主要临床表现：劳累性呼吸困难、疲劳、端坐呼吸、夜尿多、外周水肿、肺水肿等发生情况。结果A组胸痛至溶栓时间明显小于B组;A组CPK峰值明显小于B组;A组形成Q波型心肌梗死者明显少于B组,两者比较无统计学意义;随访2年A组发生再梗死的时间大于B组[（6±10）个月vs（5±7）个月],无显著差异;A组病死率小于B组[3.7%（6/161）vs8.1%（16/197）],两者无显著差异;随访时（3个月、1年、2年）A组患者发生心力衰竭临床表现：呼吸困难、肺水肿、端坐呼吸、夜尿多、疲劳、外周水肿显著少于B组。结论超早期溶栓治疗明显减少发生心力衰竭的症状,提高AM I患者生存质量。

AIM To determine whether very early treatment reduces the development of congestive heart failure in patients with acute myocardial infarction （AMI）. METHODS Three hundred and fifty-eight consecutive patients with acute myocardial infarction （AMI） were treated with UK, 161 cases within the first 1.5 hours from the onset of chest pain （ group A）, in 68 of whom fibrinolysis was initiated in the prehospital setting, and 197 cases within 1.5 to 4.0 hours （group B）. Symptoms related to heart failure, including dyspnea on exertion, fatigue, orthopnea, nocturia, and peripherial edema, in addition to pulmonary edema events, were assessed during 2-year follow-up. RESULTS The period between the onset of precordial pain to the administration of UK was significantly shorter and the mean peak levels creatine phosphokinase was significantly lower for patients in group A compared with group B. The frequency of the Q-wave MI was significantly smaller in group A compared with group B. The interval period of reinfarction was longer and mortality datd was lower in group A compared with group B, without statistical difference during 2 years of follow-up. At follow-up （at 3mon, ly, 2y） there was fewer patients had symptoms： dyspnea, pulmonary edema, orthopnea, nocturia, fatigue, and peripheral edema in group A as compared with group B. CONCLUSION Very early fibrinolytic therapy results in a significant longterm reduction of congestive heart failure-related symptoms and the therapy improves the quality of life in patients after MI.