溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效及费用效果分析

Comparison of direct PCI and thrombolytic therapy (Urokinase) for acute myocardial infarction:healing effect and cost/effect result

目的 对比直接冠状动脉内介入治疗 (PCI)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效及费用效果比。方法 采用观察性队列研究的方法 ,对 93例AMI病人采用UK溶栓 ,5 9例AMI病人采用直接PCI治疗 ,比较两组住院及随访期的超声心动图 (UCG)、临床结果及费用。结果 住院期间UCG检查室壁运动正常者在PCI组为 38 98% ,高于UK组 (2 4 73% ) (P =0 0 2 1) ,矛盾运动发生率PCI组为 0 ,而UK组为 11 83%。LVEF在PCI组为 5 6 77± 9 85高于UK组(5 2 2 3± 10 6 9) (P =0 0 2 9)。住院期心衰发生率UK组为 30 10 % ,高于PCI组 (16 90 % ) (P =0 0 6 8)。随访 (13 32± 6 86 )个月累计心衰发生率UK组为 38 70 % ,也高于PCI组 (13 6 0 % ) (P =0 0 0 1)。住院期间的病死率UK组为 10 80 % ,PCI组为3 4 0 % (P =0 0 83)。累计病死率UK组为 15 10 % ,明显高于PCI组 (3 4 0 % ) (P =0 0 14 )。 6 0岁以上年龄组累计的病死率仍然是UK组 (13 98% )高于PCI组 (3 39% ) (P =0 0 2 2 )。在随访 3、6、12及 2 4个月时PCI组的生活质量计分均高于同时期UK组的计分 (P <0 0 5 )。住院期间的费用、累计总费用及心功能获益费用均是直接PCI组高于UK治疗组。

Objective To compare the healing effect and cost/effect result of direct percutaneous coronary intervention (PCI) and thrombolytic therapy (Urokinase,UK) in acute myocardial infarction (AMI). Methods This was an observing cohort study. 93 cases of AMI were treated with thrombolytic therapy (UK), but 59 cases of AMI were treated with direct PCI. We compared the results of ultrasonic cardiograph (UCG), clinical effects and cost/effect result 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 PCI group (38.98%) than that in UK group (24.73%)(P=0.021). The rates of dyskinesia was 11.83% in UK group which was higher than that in PCI (0). The left ventricular ejection fraction (LVEF%) in PCI group(56.77±9.85) was higher than that in UK group (52.23±10.69)(P=0.029). During hospital, the rates of heart failure in PCI group (16.90%) was less than that in UK group (30.10%)(P=0.068).The accumulative heart failure rate during follow-up period in PCI group (13.60%) was also less than that in UK group (38.70%)(P=0.001).The mortality during hospital in PCI group was less than that in UK group, but which showed no significant difference. The accumulative mortality was 3.40% in PCI group which was less than that in UK group (15.10%)(P=0.014). The accumulative mortality of patients over 60 years of age in PCI group (3.39%) was also less than that in UK group (13.98%) (P=0.022). During follow-up period, the scores of life quality in patients of PCI group were higher than those in the UK group. The cost and total cost/effect result of PCI were higher than that of UK. Conclusions Direct PCI therapy limited left ventricular re-modeling, improves the rate of heart failure and mortality. But the cost and cost/effectiveness were higher.