急性心肌梗死再灌注治疗的临床研究

CLINICAL STUDY OF REPERFUSION THERAPY IN ACUTE MYOCARDIAL INFARCTION

目的 :比较不同再灌注治疗方案治疗急性心肌梗死 (AMI)的疗效和预后。方法 :119例采用常规药物治疗 ,5 7例行静脉溶栓、 14例行冠状动脉内溶栓 (PTCR)、 12例行急诊经皮冠状动脉成形术 (PTCA)。结果 :静脉溶栓治疗冠状动脉再通率为 5 2 .6 % ,其中 ,AMI发生 <6 h者再通率为 6 7.6 % ,>6 h者再通率仅为 2 0 %。PTCR再通率为 5 0 %。急诊 PTCA手术成功率为 91.7% ,2例植入冠状动脉支架成功。行 PTCR和急诊 PTCA者无一例术后出现心源性休克、脑卒中和死亡。结论 :再灌注治疗 AMI可使冠状动脉尽早再通 ,降低病死率 ,急诊 PTCA疗效最优 ,溶栓治疗成功的主要因素在于开始溶栓的时间和溶栓药物的选择。

Objective:To compare with the prognosis and the effect of four kinds of therapies on acute myocardial infarction (AMI) Methods:194 patients of AMI were divided into four groups:119 cases were treated with medicine,57 cases with intravenous thrombolysis,14 cases with intracoronary thrombolysis,12 cases with emergency percutaneous transluminal coronary angioplasty(PTCA) Results:The recanalization of intravenous thrombolysis was 52 6% Among them,the recanadization of AMI cases who got the therapy for less than 6 hours was 67 6% but those who got the therapy for more than 6 hours was only 20% The recanalization of intracoronary thrombolysis was 50% The success rate of emergency PTCA was 91 7%,in which 2 cases were implanted with two stents successfully Conclusions:The reperfusion therapy in AMI can repatency coronary artery and reduce mortality The effect on emergency PTCA is better than others The major factors of successful thombolysis were the time and medicine