直接经皮冠状动脉腔内成形术与冠状动脉内溶栓治疗急性心肌梗塞的近期疗效比较

Comparison of recent curative effects between direct percutaneous transluminal coronary angioplasty and intracoronary thrombolysis in patients with acute myocardial infarction

目的：探讨直接经皮冠状动脉腔内成形术（ＰＴＣＡ）与冠状动脉内溶栓（ＩＣＴ）治疗急性心肌梗塞（ＡＭＩ）的近期临床疗效。方法：回顾分析１９９３年８月～１９９６年１２月ＡＭＩ胸痛后４５分钟～６小时〔平均（３．４±１．６）小时〕入院患者５２例临床资料，其中１９９５年８月前２４例行国产尿激酶ＩＣＴ，１９９５年８月后２８例行直接ＰＴＣＡ，以ＡＭＩ溶栓试验（ＴＩＭＩ）３级血流为血管再通标准。结果：ＩＣＴ与直接ＰＴＣＡ２组血管再通率分别为４１．７％和８９．３％（Ｐ＜０．００１），再通血管残留狭窄平均为９０．４％±６．７％和１４．５％±１０．３％（Ｐ＜０．００１），血管再通距胸痛发病时间２组差异无显著性（Ｐ＞０．０５），再通存活患者梗塞后早期（起病后３０日内）心绞痛发生率分别为３０．０％（３／１０）和４．３％（１／２３），Ｐ＜０．０５。结论：在条件和设备允许的医院，可优先考虑直接ＰＴＣＡ治疗ＡＭＩ，以获彻底可靠的血管再通，ＩＣＴ可作为ＰＴＣＡ失败后的补充措施。

Objective:To compare the recent curative effects between direct percutaneous transluminal coronary angioplasty (PTCA) and intracoronary thrombolysis (ICT) in patients with acute myocardial infarction (AMI).Methods:From August 1993 to December 1996,52 patients with AMI were admitted to hospital within 075￣600 hours 〔average(34±16)hours〕 after angina.Among the cases,24 cases were treated by ICT with Chinamade urokinase before August 1995,and the other 28 cases were treated by PTCA after August 1995.The grade 3 perfusion of the thrombolysis in myocardial infarction (TIMI) was used as the standard of coronary artery repatentcy.Results:The repatency rates of the coronary artery in ICT and PTCA were 417% and 893%,respectively (P<0001).The incidences of remained stricture in the repatency coronary artery were 904%±67% and 145%±103%,respectively (P<0001).There was no difference in interval from angina to coronary artery repatency between 2 groups (P>005).In addition,the incidences of premature angina in survivors with repatency were 300% (3/10) and 43% (1/23),respectively (P<005).Conclusions:In order to acquire complete coronary artery repatency,it is the first choice to treat AMI by use of PTCA in the hospital wherever conditions and facilities are permitted.ICT can be used as a complementary measure if PTCA treatment are failed.