急性心肌梗死直接介入治疗与静脉溶栓及补救介入治疗的临床疗效

The study on the clinical effects and short-term results of time-limited rescue angioplasty following thrombolytic therapy in acute myocardial infarction

目的 探讨急性心肌梗死 (AMI)静脉溶栓与时间限定性补救经皮冠状动脉腔内介入(PCI)顺序疗法的合理性、安全性及有效性。方法 1999年 1月至 2 0 0 2年 10月入院的 10 2例AMI患者中 ,4 4例接受直接PCI治疗 ,5 8例首先接受尿激酶静脉溶栓 ,限定自溶栓开始 90min内仍未再通者立即行补救性PCI,溶栓再通者则行择期冠状动脉造影 ,选择治疗方案。对以上两种方法的再通率、并发症、第 4周左室射血分数 (LVEF)等临床资料进行分析 ,对静脉溶栓与时间限定性补救PCI顺序疗法的可行性、安全性、有效性进行评价。结果 直接PCI组再通率 95 4 5 % (4 2 / 4 4 ) ,静脉溶栓 +拟行时间限定性补救PCI组 90min内溶栓再通率 32 76 % (19/ 5 8) ,补救PCI再通率 97 4 3% (38/ 39) ;直接PCI组 2例于支架置入后出现无或缓再流现象 ,静脉溶栓未通 +时间限定性补救PCI者 1例出现缓再流现象 ,静脉溶栓再通者至择期介入诊疗前无梗死相关血管 (IRA)再闭塞 ;直接PCI组消化道出血 2例 ,溶栓未通 +补救PCI组 1例出现血尿 ,无其它出血及穿刺部位血肿发生 ;第 4周超声心动图检查结果 :直接PCI组平均LVEF为 5 9 5 % ,静脉溶栓未通 +补救PCI组为 5 8 8% ,溶栓再通 +延迟PCI组为 6 0 4 % (P >0 0 5 ) ,6h以内再通者LVEF为 6 2 7% ,6h以?

Objective To evaluate the rationality, safety and efficiency of the time-limited rescue angioplasty following thrombolytic therapy in acute myocardial infarction (AMI).Methods Among the patients within 6 hours from the onset of symptoms of AMI, forty-four cases (group A) underwent primary coronary angioplasty and fifty-eight cases (group B) underwent firstly intravenous thrombolytic therapy. According to clinical early reperfusion indication within 90 minutes following thrombolytic therapy, group B was divided into two subgroups, the patients with early reperfusion (subgroup C) underwent delayed interventional examination 7～10 days after AMI and that with non-reperfusion (subgroup D) underwent rescue angioplasty. The reperfusion rates and complications in different groups were analyzed and compared. Cardiac function (left ventricular ejection fraction, LVEF) was evaluated by echocardiograph 4 weeks after AMI. Results The results showed that the rate of reperfusion, in group A, was 95.45% (42/44),that of subgroup C was 32.76 % (19/58) within 90 minutes following thrombolytic therapy (16 of subgroup C underwent delayed interventional examination and 12 of them underwent PTCA+stent) and that of subgroup D was 97.43% (38/39); There were no serious complications that occurred in subgroups C and D. The LVEFs in group A, subgroups C and D were not significantly different, but there was a significant difference between reperfusion within 6 hours and beyond after AMI (62.7% vs 56.8%, P<0.05) reperfusion method in AMI.Conclusion The time-limited rescue angioplasty following thrombolytic therapy is a rational, safety and efficient.