急性心肌梗死溶栓后介入与急诊介入的疗效对比

Comparison on the Effects of PCI After Thrombolysis and Emergency PCI for the Treatment of Acute Myocardial Infarction

目的比较急性心肌梗死患者直接经皮冠状动脉介入治疗和静脉瑞替普酶溶栓后介入治疗的效果。方法回顾性分析我院2014年1月至2015年10月收治的急性心肌梗死患者66例,其中溶栓-介入组25例为瑞替普酶溶栓后介入治疗,急诊介入组41例接受直接急诊介入治疗,比较两组的治疗效果。结果溶栓-介入组患者的发病至接受开通血管治疗的时间显著短于急诊介入组(P<0.05),CK-MB峰值显著高于急诊介入组(P<0.05)。两组在介入成功率、死亡率、近期心脏不良事件发生率、心脏射血分数、左室内径方面无统计学差异(P>0.05)。结论溶栓后介入治疗并未增加患者的出血、死亡等风险,其近期疗效与急诊介入治疗相当。无条件行急诊介入治疗的患者在溶栓后及时行造影检查并根据病情进行干预是改善冠脉血供的有利措施。

Objective To compare the effects ofpercutaneous coronary intervention （PCI） after thrombolysis and emergency PCI for the treatment of acute myocardial infarction （AMI）. Methods A total of 66 AMI patients were analyzed retrospectively. 25 patients who received PCI after thrombolysis by reteplase were set as thrombolysis-PCI group, and 41 patients who received emergency PCI were set as the emergency PCI group. The clinical effects of two groups were compared. Results The time from onset to therapy of thrombolysis-PCI group was significantly shorter than that of emergency PCI group （P〈0.05）, and the CK-MB peak value was significantly higher than that of emergency PCI group （P 〈0.05）. No statistical difference was found between two groups in the successful rate of PCI, mortality, recent adverse cardiac event rate, cardiac ejection fraction and left ventricular diameter （P 〉0.05）. Conclusions PCI after thrombolysis does not increase the risk of bleeding and death of patients, and has similar efficacy with emergency PCI. Timely angiography after thrombolysis and therapy for patients with unconditional emergency PCI are advantageous measures to improve the coronary blood supply.