急性心肌梗死患者溶栓失败后经皮冠状动脉介入补救治疗的时机

Remediation time of percutaneous coronary intervention in patients with acute myocardial infarction after thrombolytic failure

目的探讨急性心肌梗死患者溶栓失败后经皮冠状动脉介入(PCI)补救治疗的最佳时机。方法根据溶栓失败后行补救PCI的不同时机,将94例急性心肌梗死患者分为观察组52例(溶栓失败后立即转诊至上级医院行PCI治疗)和对照组42例(继续保守治疗,再次出现心肌缺血症状后转诊至上级医院行PCI治疗)。比较2组治疗前后心肌酶含量及左心室功能,并观察治疗后1年内不良事件的发生情况,包括死亡、再梗死、难治性心肌缺血、消化道出血等。结果治疗后3 d,2组肌酸激酶同工酶(CK-MB)、心肌钙蛋白T(c Tn T)、心肌钙蛋白I(c Tn I)含量均明显降低,其中观察组降低幅度更大(P<0.01)。治疗后1周,2组左心室功能均明显改善,观察组左心室射血分数(LVEF)明显高于对照组,左心室收缩末期容积(LVESV)和左心室舒张末期容积(LVEDV)明显低于对照组(P<0.01)。治疗后1年内,观察组不良事件总发生率明显低于对照组(P<0.01)。结论溶栓失败后立即行PCI治疗有助于减轻急性心肌梗死患者的心肌细胞损伤,改善左心室功能和预后。

Objective To explore the best remediation time of percutaneous coronary intervention（ PCI） for patients with acute myocardial infarction（ AMI） after thrombolytic failure. Methods According to different remediation time of PCI after thrombolytic failure,94 patients with AMI were divided into two groups. Patients in the observation group（ n = 52） were transferred to superior hospitals immediately to undergo PCI after thrombolytic failure,and patients in the control group（ n =42） received conservative treatment continuously in local hospitals and were transferred to superior hospitals to undergo PCI after reappearance of myocardial ischemic symptoms. The contents of myocardial enzymes and left ventricular function were compared before and after treatment in both groups,and the condition of adverse reactions,including deaths,re-infarction,refractory myocardial ischemia and gastrointestinal bleeding were observed within 1 year after treatment. Results Three days after treatment,the contents of creatine kinase MB（ CK-MB）,cardiac troponin T（ c Tn T） and cardiac troponin I（ c Tn I） in both groups decreased significantly,and the decreased range in observation group was larger（ P〈0. 01）. One week after treatment,the left ventricular function in both groups improved significantly. The left ventricular ejection fraction（ LVEF） in observation group was significantly higher than the control group,while left ventricular end-systolic volume（ LVESV） and left ventricular end-diastolic volume（ LVEDV） were significantly lower（ P〈0. 01）. Within 1 year after treatment,the total incidence rate of adverse reactions in the observation group was significantly lower than that in the control group（ P〈0. 0 1）. Conclusion Immediately application of PCI after thrombolytic failure is helpful to relieve cardiomyocyte injury and improve left ventricular function and prognosis of patients with AMI.