溶栓后早期经皮冠状动脉介入治疗急性ST段抬高型心肌梗死

发布时间：2018-08-26 11:46

【摘要】：背景:直接经皮冠状动脉介入治疗(PCI)、溶栓后24小时内PCI及缺血引导/延期PCI为治疗ST段抬高型心肌梗死的三种方法。90-120分钟内及时行PCI是治疗急性ST段抬高型心肌梗死患者(STEMI)的最优策略。然而,在临床实践中,很多病例不能在这个时间区间内被送到医院并接受PCI。在转运过程中早期行溶栓治疗,理论上可以更早地改善其梗死及缺血心肌的供血和预后。对于STEMI患者,如果不能在120分钟内转运至介入中心,直接PCI、溶栓后早期行PCI、缺血引导/延期PCI,哪种方式能给患者带来更大的获益仍没有足够的证据。目的:研究探索溶栓后24小时内PCI,分别与直接PCI和缺血引导/延期PCI进行比较,旨在纳入更多的临床研究和病例,探讨溶栓后24小时内PCI的有效性和安全性。方法:检索Pub Med、EMBASE、Google scholar和Cochrane数据库,纳入比较溶栓后24小时内PCI与直接PCI和(或)缺血引导/延期PCI治疗症状出现12小时内的STEMI的临床随机对照试验(RCT)。利用Rev Man 5.30软件进行meta分析。结果:本研究共纳入16项随机对照研究,涉及10034例患者。溶栓后易化PCI(溶栓后120分钟内行PCI)的短期死亡率(5.8%vs 4.5%,RR 1.29,95%CI 1.00-1.65)和再次心肌梗死率(4.1%vs 2.7%,RR 1.46,95%CI 1.05-2.03)显著高于直接PCI。溶栓后早期PCI(溶栓后2-24小时内行PCI)的短期死亡率、再次心肌梗死率与直接PCI相当。以上两种方法均会造成主要出血事件增多。溶栓后早期PCI的短期再次心肌梗死率(2.4%vs 4.0%,RR 0.66,95%CI 0.46-0.94)和再缺血率(1.5%vs 5.3%,RR 0.29,95%CI 0.12-0.70)明显低于溶栓后缺血引导/延期PCI,这种优势在长期随访中得以保持。结论:针对于不符合90-120分钟内行急诊PCI的STEMI患者,溶栓后易化PCI有害;溶栓后早期PCI,赢得了更多的转移、PCI准备时间,与直接PCI疗效相当,比溶栓后缺血引导/延期PCI疗效更好。
[Abstract]:Background: PCI and ischemic guided / delayed PCI are three methods to treat ST segment elevation myocardial infarction within 24 hours after direct percutaneous coronary intervention for (PCI), thrombolytic therapy. 90-120 minutes PCI is the treatment of acute ST segment elevation myocardial infarction. Optimal strategy for (STEMI) in patients with infarction. However, in clinical practice, many cases cannot be taken to hospital and accepted PCI. within this time interval Thrombolytic therapy in the early stage of transport can improve the blood supply and prognosis of infarct and ischemic myocardium earlier. For patients with STEMI, if they cannot be transported to the interventional center within 120 minutes, there is no sufficient evidence that which way of PCI, ischemic guided / delayed PCI, can bring more benefit to patients early after direct PCI, thrombolysis. Objective: to investigate the efficacy and safety of PCI, in 24 hours after thrombolysis compared with direct PCI and ischemic guided / delayed PCI in order to include more clinical studies and cases and to explore the efficacy and safety of PCI within 24 hours after thrombolysis. Methods: Pub Med,EMBASE,Google scholar and Cochrane databases were searched, and the clinical randomized controlled trial (RCT). Was used to compare PCI within 24 hours after thrombolytic therapy with STEMI with direct PCI and / or ischemic guided / delayed PCI treatment within 12 hours after thrombolytic therapy. Meta analysis was carried out with Rev Man 5.30 software. Results: this study included 16 randomized controlled trials involving 10034 patients. Short-term mortality (5.8%vs 4.5) and re-myocardial infarction rate (RR 1.2995 CI 1.00-1.65) of PCI (PCI within 120 minutes after thrombolysis) were significantly higher than that of direct PCI. (RR 2.77 CI 1.05-2.03). The short-term mortality of early PCI (PCI within 2-24 hours after thrombolysis) was similar to that of direct PCI. Both of the above methods will result in an increase in the number of major bleeding events. The short-term re-myocardial infarction rate (2.4%vs 4.0-RR 0.6695 CI 0.46-0.94) and the reischemia rate (1.5%vs 5.3R 0.2995CI 0.12-0.70) of early PCI after thrombolysis were significantly lower than that of PCI, after thrombolysis. Conclusion: it is harmful to facilitate PCI after thrombolytic therapy in STEMI patients who are not in accordance with emergency PCI within 90-120 minutes after thrombolytic therapy, and the early PCI, after thrombolytic therapy won more preparation time of PCI, metastasis, which is comparable to the effect of direct PCI, and is better than that of ischemic guidance / delayed PCI after thrombolytic therapy.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R542.22

【相似文献】