不同救治手段对急性心肌梗死转归的影响

The effects of different remedies on acute myocardial infarction

目的对比分析12h内来院的急性心肌梗死(AMI)患者采用溶栓,直接冠脉成形术和转院后急诊冠脉成形术治疗方法对AMI患者预后的影响。方法将2004年1月-2005年12月来院的AMI12h内患者采取连续入组的方式分为溶栓治疗组(32例)和直接冠脉成形术治疗组(63例),以及外院转院于12h内行急诊冠脉成形术治疗组(25例),比较3组患者在院期间和出院后1年转归的差别。结果与直接冠脉成形术和转院后急诊冠脉成形术相比,溶栓组到院至再通时间间隔最短,分别平均为(1.1±0.2)h、(2.3±1.0)h和(2.1±1.1)h,(P<0.01),病死率(分别为6.3%、3.2%和4.0%)和1年后病死率(分别为12.5%、4.8%和8.0%)均未达统计学意义,溶栓组非致死性再梗死的发生率显著高于PCI组(分别为18.8%和4.5%,P<0.05)。结论AMI的救治关键是尽早开通罪犯血管,转院治疗也是较为安全有效的治疗方式。

Objective To investigate the different treatment effects of intravenous thrombolysis vs primary coronary angioplasty and interhospital transfer for primary coronary angioplasty in acute myocardial infarction within 12 hours after onset. Methods During January 2004 to December 2005, 63 consecutive patients with acute myocardial infarction admitted directly for primary PCI and 25 patients transferred from other hospitals for primary PCI were compared with 32 patients treated with intravenous thrombolysis. Each patients arrived at hospital within 12 h from chest pain onset. T-test and Chi-square test were used to analyze the rate of mortality, re-infarction, heart failure in-hospital and 1-year latter. Results Among the 3 groups, for group of intravenous thrombolysis, time interval from arriving to having reflow was the shortest （1.1 ± 0.2 h vs 2.3 ± 1.0 h vs 2.1 ± 1.1 h, P 〈 0.01）, the mortalities in hospital （6.3% vs 3.2% vs 4.0%） and 1-year follow up （12.5% vs 4.8% vs 8.0% ）were highest in spite of no statistic difference. After 1 year, the rate of reinfarction in intravenous thrombolysis group is higher than that in PCI group （18.8% vs 4.5%, P 〈 0.05）. Conclusions The key point of AMI remedy is to open the criminal vessel as fast as possible. Interhospital transfer for PCI is feasible and safe.（J Intervent Radiol, 2007, 16： 630-633）