推广溶栓后转运经皮冠状动脉介入治疗,提高边疆地区急性ST段抬高型心肌梗死再灌注治疗率

Promote PCI transfer after thrombolysis to increase the treatment rate of acute STEMI reperfusion in boroler areas

目的:比较溶栓后转运经皮冠状动脉介入治疗(PCI)与直接PCI的治疗效果,为提高基层医院急性ST段抬高型心肌梗死(STEMI)再灌注治疗率提供有效解决方法。方法:分析2019年12月-2020年12月胸痛中心录入的STEMI患者数据,外院溶栓并于溶栓后2~24 h转运至该中心行急诊PCI的患者进入溶栓后转运PCI组20例;首诊于该中心或直接转运至该中心,发病12 h内行急诊PCI的患者进入直接PCI组77例。比较两组患者PCI前后TIMI血流情况,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)峰值,出院前心脏超声情况及出院后30 d内死亡、再梗死、脑卒中、再发心绞痛及出血事件发生率。结果:溶栓后转运PCI组从发病到导丝通过罪犯血管的时间明显长于直接PCI组,罪犯血管TIMI血流3级的比例高于直接PCI组;但在PCI治疗后,两组最终TIMI血流3级的比例无明显差异。两组患者入院后的CK和CK-MB峰值,出院前心脏超声左室舒张末期内径(LVDd)、左室射血分数(LVEF)以及出院后30 d内心脑血管事件的发生率亦无明显差异。结论:溶栓后转运PCI在疗效上并不逊色于直接PCI,大力推广溶栓后转运PCI是提高边疆地区急性STEMI再灌注治疗率的有效措施。

Objective:To compare the therapeutic effects of PCI after thrombolysis and direct PCI,and to provide an effective solution to improve the treatment rate of acute STEMI reperfusion in primary hospitals.Methods:Analyzing the data of STEMI patients entered from December 2019 to December 2020 in the chest pain center.Patients who were thrombolized in an outside hospital and transferred to the center for emergency PCI 2 to 24 h after thrombolysis were included in the post-thrombolysis transfer PCI group of 20 patients.77 patients who were first seen at the center or transferred directly to the center and underwent emergency PCI within 12 h of onset were entered into the direct PCI group.The TIMI blood flow,CK and CK-MB peaks before and after PCI,the echocardiography before discharge,and the incidence of death,reinfarction,stroke,recurrent angina and bleeding events within 30 days after discharge were compared between the two groups of patients.Results:The time from onset to guidewire passage through the offender's vessel was significantly longer in the post-thrombolytic transfer PCI group than in the direct PCI group,and the proportion of TIMI flow grade 3 in the offender's vessel was higher than in the direct PCI group.However,there was no significant difference in the proportion of final TIMI flow grade 3 between the two groups after PCI treatment.There were also no significant differences in peak CK and CK-MB after admission,pre-discharge cardiac ultrasound LVDd,LVEF,or the incidence of cardiovascular events within 30 d after discharge between the two groups.Conclusion:Post-thrombolytic transfer PCI is not inferior to direct PCI in terms of efficacy,and vigorously promoting post-thrombolytic transfer PCI is an effective measure to improve the rate of acute STEMI reperfusion treatment in border areas.