溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效分析

A comparison of direct angioplasty with Urokinase thrombolytic therapy for acute myocardial infarction

目的 对比直接冠状动脉腔内成形术 (PTCA)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效。方法 采用观察性队列研究的方法 ,对 97例AMI患者采用UK溶栓 ,60例AMI患者采用直接PTCA治疗 ,比较两组住院期及随访期的超声心动图 (UCG)和临床结果。结果 住院期间UCG检查室壁运动正常者在PTCA组为 (4 6.0 0 % ) ,高于UK组 (2 4.73 % ) (p =0 .0 2 1) ,矛盾运动发生率PTCA组为 0 ,而UK组为 11.83 %。LVEF在PTCA组为 5 6.88± 10 .47,高于UK组 (5 1.5 8± 10 .97) (p =0 .0 41)。住院期心衰发生率UK组为 3 2 .5 9% ,高于PTCA组 (18.3 3 % ) (p =0 .0 2 9)。随访 13 .3 2± 6.86个月累计心衰发生率UK组为 16.2 8% ,也高于PTCA组 (5 .19% ) (p =0 .0 0 1)。住院期间的病死率UK组为 10 .3 1% ,PTCA组为 5 .0 0 % (p =0 .10 0 )。累计病死率UK组为 15 .5 6% ,明显高于PTCA组 (5 .0 0 % ) (p =0 .0 2 1)。 60岁以上年龄组累计的病死率仍然是UK组 (2 8.99% )高于PTCA组 (10 .3 4% ) (p =0 .0 49)。在随访 3、6、12及 2 4个月时PTCA组的生活质量计分各自为 :5 9.90± 14 .67、74.40± 12 .86、73 .86± 9.70、82 .47± 10 .47均高于同时期UK组的计分 (分别是 5 2 .0 8± 14 .49、65 .0 0± 14 .72、67.0

Objective:To compare the effect of direct percutaneous transluminal coronary angioplasty (PTCA)and Urokinase (UK) thrombolytic therapy in acute myocardial infarction(AMI). Methods:This is an observing cohort study. 97 cases of AMI were treated by emergency PTCA while 60 cases of AMI were treated by thrombolytic therapy with UK. We then compared the results of echocardiogrophic examination (UCG) and clinical effects both in hospital and the follow-up period. Results:In hospital period , the UCG examination showed that the percentage of patients with normal wall motion was higher in PTCA group (46.00%) than that in UK group(24.73%)(p=0.021).The rates of dyskinesia was 11.83% in thrombolytic group and higher than that in PTCA (0) .The left ventricular ejection fraction (LVEF %) in PTCA group ( 56.88±10.47) was higher than that in UK group(51.58±10.97)(p=0.041)?During hospital , the rates of heart failure in PTCA group (18.33%) was less than that in UK group (32.59%) (p=0.029). The accumulative heart failure rate during follow-up period in PTCA group (5.19%) was also less than that in UK group(16.28%)(p=0.001). The mortality during hospital in PTCA group was less than that in UK group, but showed no significant difference. The accumulative mortality was 5.00% in PTCA group and less than that in UK group (15.56%) (p=0.021). The accumulative mortality of patients over 60 years of age in PTCA group(10.34%)was also less than that in UK group(28.99%)(p=0.049)?During follow-up, the scores of life quality in patients of PTCA group were higher than those in the UK group. Conclusion:direct PTCA therapy limited left ventricular re-modeling, improves the heart function and quality of life , decreases the rate of heart failure and mortality.