急诊溶栓联合择期经皮冠状动脉介入治疗急性心肌梗死的疗效及安全性评价

Clinical effects study of acute thrombolytic therapy combined with selective PCI on acute myocardial infarction

目的:考察急性溶栓在心肌梗死介入治疗中的疗效和安全性。方法:将200例急性心肌梗死(AMI)患者随机分为研究组和对照组,每组100例。对照组患者在确诊后立即进行介入治疗,而研究组患者先给予急性溶栓治疗后择期进行介入治疗。比较2组患者入院时和介入治疗后7d的左室射血分数(LVEF)、肌酸磷酸激酶(CPK)峰值、CPK高峰时间、血清磷酸肌酸激酶同功酶(CK-MB)峰值、CK-MB高峰时间、住院期间心脏破裂率、梗死复发率、30d病死率和1年内病死率。结果:研究组和对照组患者介入治疗7d后的LVEF分别为(56.2±6.7)%和(49.4±6.1)%;CPK峰值分别为(111.7±49.0)U/L和(79.1±51.2)U/L;CPK高峰时间分别为(14.1±4.4)s和(18.9±6.1)s;CK-MB峰值分别为(2586.8±1593.2)ng/ml和(1981.3±1252.1)ng/ml;CKMB高峰时间分别为(13.0±6.0)s和(20.1±6.7)s。2组患者的心功能指标比较差异有统计学意义(P<0.01);研究组患者院内主要不良心血管事件(MACE)发生率显著低于对照组(P<0.05);研究组患者院内生存率与对照组差异无统计学意义(P>0.05),但1年随访数据显著优于对照组(P<0.05)。结论:急性溶栓在AMI患者的介入治疗中效果更优且安全性更佳,具有临床应用价值。

Objective：To study the clinical effects and safety of acute thrombolytic therapy combined with selective PCI on acute myocardial infarction.Method：A total of 200 acute myocardial infarction patients were randomly divided into study group and control group.One hundred patients in control group were treated with percutaneous coronary intervention（PCI）as soon as confirmed.One hundred patients in study group were treated with acute thrombolytic therapy as soon as confirmed and selective PCI.The left ventricular ejection fraction（LVEF）,CPK peak level,CPK peak time,CK-MB peak level,CK-MB peak time,cardiac rupture rate,infarction recurrent rate and mortality in 30 dand 1year between two groups were compared.Result：The LVEF in study group and control group was（56.2±6.7）% and（49.4±6.1）%,the CPK peak level was（111.7±49.0）U/L and（79.1±51.2）U/L,the CPK peak time was（14.1±4.4）s and（18.9±6.1）s,the CK-MB peak level was（2 586.8±1 593.2）ng/mL and（1 981.3±1 252.1）ng/mL,the CK-MB peak time was（13.0±6.0）s and（20.1±6.7）s respectively.There was a significant difference between two groups in all indexes（P〈0.01）.The MACE rate in study group was 4.0% which was significantly lower than 17.0%in control group（P〈0.05）.There was no significant difference in-hospital survival rate between two groups（P〉0.05）.However,there was a significant difference in survival rate at one year after treatment（P〈0.05）.Conclusion：Acute thrombolytic therapy combined percutaneous coronary intervention has a better clinical effects and safety on acute percutaneous coronary intervention,that worth for clinical application.