急性心肌梗死延迟冠脉介入治疗的临床观察

Clinical observation of delayed coronary intervention in patients with acute myocardial infarction

目的：观察延迟经皮冠脉介入治疗（DPCI）在急性心肌梗死患者中的应用,并与静脉溶栓临床效果及预后比较。方法：选择2010年5月至2015年5月我院120例急性心肌梗死患者,发病3 h内溶栓为A组,3~6 h溶栓为B组,〉6~12 h溶栓为C组,未溶栓及早期PCI治疗且于7~10 d行DPCI者为D组,每组30例。比较4组患者的疗效及6个月后心脏不良事件。结果：A组、B组、D组的冠脉再通率明显高于C组,A组、B组、D组的出血率和反复心绞痛发生率明显低于C组,组间差异有统计学意义（P〈0.05）。随访6个月延迟PCI组心脏不良事件发生率低于溶栓组,尤其与溶栓时机较晚的C组比较差异有统计学意义（P〈0.05）。结论：DPCI同样使失去溶栓时机或不能早期PCI的急性心肌梗死患者获益。

Objective： To observe the application of delayed percutaneous coronary intervention in patients with acute myocardial infarction, compare with the clinical effect and prognosis of intravenous thrombolysis. Methods： 120 cases of acute myocardial infarction treated in our hospital from May 2010 to May 2015 were selected. According to the onset to thrombolysis time, patients were divided into 3 groups：Below 3 hours for group A, 3 ~6 hours for group B, 6 ~12 hours for group C,patients with non thrombolysis and early PCI therapy were treated with percutaneous coronary intervention in 7 ~10 days divided into the study of group D. Each group contained 30 patients. The curative effect during hospitalization and adverse cardiac events of the four groups were compared after six months. Results：The coronary arteries pass rate in group A, group B and group D was significantly higher than that of group C. The bleeding rate and recurrent angina of the group A, group B and group D were significantly lower than that of the group C, obvious difference between the groups was found（P 0.05）. The incidence of adverse cardiac events in the delayed PCI group was lower than that in the thrombolysis group after sixmonths. There were significant differences in the group C who was relatively late start the thrombolysis（P 0.05）.Conclusion： Patients who has loss of thrombolytic therapy or early PCI therapy obtain the same benefits by delayed percutaneous coronary intervention.