急诊冠状动脉腔内成形术及支架术与溶栓治疗急性心肌梗死的临床分析

Emergency percutaneous transluminal angioplasty,inter coronary stent and thrombolytic therapy in acute myocardial infarction

目的 探讨急性冠状动脉腔内成形术 (PTCA)及支架术 (ICS)对急性心肌梗死 (AMI)的临床疗效。方法 对 5 6例AMI病人行急诊PTCA及ICS治疗 (PTCA及ICS组 ) ,6 2例AMI病人行溶栓治疗 (溶栓组 ) ,比较两组住院和随诊期间的情况。结果 PTCA及ICS组住院期间死亡 3例 ,抢救成功率为 98 2 % ,平均住院天数为 10 5d(7± 6 5d) ,左室射血分数 (LVEF)为 5 2 5 %± 5 5 % ;随诊 6个月 ,心绞痛发作 2例 ,择期再次PTCA 2例。溶栓组住院期间死亡 7例 ,抢救成功率为 88 7% ,平均住院天数为 2 5 5d(17± 8 5d) ,LVEF为 4 0 5 %± 5 5 % ,随访 6个月 ,心绞痛发作 16例 ,行择期PTCA 16例。结论 急性心肌梗死急诊PT CA可即时开通梗死相关血管 (IRA) ,大大降低AMI的住院病死率 (P <0 0 1) ,缩短住院天数 (P <0 0 1) ,有效保护心脏功能 (P <0 0 5 )。

Objective To explore the effect of emergency percutaneous transluminal coronanry angioplasty(PTCA),inter coronary stent(ICS) and PCTA+ICS on acute myocardial infarction(AMI).Methods Fifty-six cases of AMI were treated by emergency PTCA+ICS while 62 cases of AMI were treated by thrombolytic therapy.The clinical effect between two groups was compared both in hospital and the follow-up period.Results In the emergency PTCA group,3 cases died while 55 cases were successful cured(success rate 98.2%) and the average hospitalization days were 10.5d.In this group the left ventricular ejection fraction(LVEF) was 52.5%±5.5%.During the follow up period 2 cases of angina pectoris were found and 2 cases underwent selective PTCA again.In the group of thrombolysis,7 cases died while 55 cases were successful cured(success rate 88.7%) and the average hospitalization days was 25.5d.In this group the LVEF was 40.5%±5.5%.During the follow-up period of 6 months,16 cases of angina pectoris occurred again and 16 cases accepted the treatment of selective PTCA.Conclusion The infarct related arteries(IRA) can be revascularized with emergency PTCA in AMI.The treatment of emergency PTCA can reduce the ratio of sudden death and the days in-hopsital(P<0.01),and this treatment can protect the ventricular function effectively(P<0.05).