逆向溶栓联合PCI术对急性ST段抬高型心肌梗死的疗效观察

Observation of curative effect of reverse thrombolysis combined with PCI on acute ST - segment elevation myocardial infarction

目的观察逆向溶栓联合经皮冠状动脉介入治疗（PCI）术对急性ST段抬高型心肌梗死（STEMI）心肌的疗效。方法将48例急性STEMI患者随机分成逆向溶栓联合PCI组和直接PCI组（每组各24例），逆向溶栓联合PCI术是指经微导管将尿激酶原注射至闭塞段以远进行逆向溶栓，然后再进行PCI，比较两种方法中慢血流无复流的发生率、再灌注心律失常的发生率和出血发生率。结果逆向溶栓联合PCI组出现1例慢血流，PCI术后1例出现一过性心动过缓，而PCI组出现3例慢血流，2例无复流，PCI术后6例出现室一过性室速，2例给予电复律，2例出现一过性心动过缓；两组均无脑出血、消化道出血等情况，2例患者出现反复心力衰竭症状。两组比较术后慢血流无复流的发生率（P=0．013），再灌注心律失常的发生率有明显的统计学意义（P=0．001），出血的发生率无统计意义（P=1．000）。结论对于急性STEMI患者，逆向溶栓联合PCI术能够明显减少慢血流无复流及再灌注心律失常的发生，从而改善患者的远期预后，同时并未增加出血等并发症的发生率。

Objective To observe the effect of reverse thrombolysis combined with PCI on acute ST - segment elevation myocardial infarction. Methods 48 patients with acute ST - segment elevation myocardial infaretion were randomly divided into two groups： reverse thrombolysis eombined with PCI group and direct PCI group, including 24 patients respectively. Reverse thrombolysis eombined with PCI means that pro - urokinase is injected into the occlusion segment for reverse thrombolysis, then PCI is performed. The incidences of slow - flow and no - reflow, the incidence of reperfusion arrhythmia, the incidence of bleeding in the two methods were compared. Results In the reverse thrombolysis combined with PCI group, slow -reflow in 1 case, transient bradyeardia after PCI in 1 case, while in PCI group, slow - reflow in 3 cases, no - reflow in 2 cases, transient ventrieular taehyeardia after PCI in 6 cases, electrical conversion given to 2 cases, transient bradycardia in 2 cases, no cerebral hemorrhage and gastrointestinal bleeding occurring in both groups, and symptoms of repeated heart failure oecurring in 2 cases. After comparison of both groups, the incidence of postoperative slow - reflow and no - reflow （P = 0. 013 ） , and the incidence of reperfusion arrhythmia （P = 0. 0（31 ） were statistically significant, and the incidence of bleeding （P = 1. 000） was of no statistical significance. Conclusions With regard to the acute ST - segment elevation myocardial infarction, reverse thrombolysis combined with PCI can significantly reduce the occurrence of slow - reflow and no - reflow and reperfusion arrhythmia, and thus improve the long - term prognosis of patients, without increasing the incidence of bleeding and other complications.