区域救治体系中急性ST段抬高型心肌梗死溶栓后早期介入与直接介入的疗效比较

发布时间：2018-02-09 22:48

本文关键词： 区域化网络协同救治急性ST段抬高型心肌梗死溶栓经皮冠状动脉介入治疗　出处：《中国老年学杂志》2017年19期 　论文类型：期刊论文

【摘要】：目的比较急性ST段抬高型心肌梗死(STEMI)溶栓后早期经皮冠状动脉介入治疗(PCI)与直接PCI的疗效。方法 STEMI患者89例根据治疗方法分为溶栓后早期PCI组41例和直接PCI组48例,分别对两组梗死相关动脉(IRA)的再通率、并发症发生率、支架植入术、住院期间死亡率及1个月后患者左室射血分数(LVEF)等指标进行比较。结果 PCI术前,溶栓后早期PCI组血管开通率85.4%(19.5%TIMI 2级,65.9%TIMI 3级血流),明显高于直接PCI组(18.7%,10.4%为TIMI 2级血流,8.3%TIMI 3级血流,P0.001)。两组PCI术后TIMI血流分级无统计学差异(P=0.653),但溶栓后早期PCI组所用支架数更少。两组住院期间不良事件发生率(大出血、再梗死、急性左心衰竭和住院天数)无显著差异(P0.05)。1个月后随访LVEF、左室舒张末期内径(LVEDd)、心源性死亡、再梗死、脑卒中等无显著差异(P0.05)。结论溶栓后早期PCI治疗是一种有效、安全的替代再灌注策略。
[Abstract]:Objective to compare the efficacy of early percutaneous coronary intervention (PCI) and direct PCI after thrombolytic therapy in patients with acute ST-segment elevation myocardial infarction. Methods Eighty-nine patients with STEMI were divided into early post-thrombolytic PCI group (41 cases) and direct PCI group (48 cases). The recanalization rate, complication rate, stent implantation, in-hospital mortality and left ventricular ejection fraction (LVEF) were compared between the two groups after PCI. The vascular patency rate of the early PCI group after thrombolysis was 85.4% and that of TIMI 2 grade 65.9 was significantly higher than that of the direct PCI group (18.710.4%). There was no significant difference in the TIMI blood flow grade after PCI between the two groups (P 0.653), but the branches used in the early PCI group after thrombolytic therapy were significantly higher than those in the direct PCI group (10.4%). The incidence of adverse events during hospitalization (haemorrhage, haemorrhage) was lower in both groups. There was no significant difference in re-infarction, acute left heart failure and hospital stay (P 0.05). After 1 month of follow-up, there was no significant difference in LVEF, left ventricular end-diastolic diameter (LVED), cardiac death, reinfarction, stroke and so on. Conclusion early PCI treatment after thrombolytic therapy is effective. Safe alternative reperfusion strategy.
【作者单位】：东营市人民医院心内科一病区;
【基金】：山东省医药卫生科技发展计划项目(No.2014WS0024)
【分类号】：R542.22

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