中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2011年
7期
55-58
,共4页
急性心肌梗死%高危因素%尿激酶%支架%近期病死率
急性心肌梗死%高危因素%尿激酶%支架%近期病死率
급성심기경사%고위인소%뇨격매%지가%근기병사솔
Acute myocardial infarction%Higher risk factors%Urokinase%Stent%Short-term mortality
目的 探讨急诊经皮冠状动脉介入治疗(PCI)对高危急性心肌梗死患者近期病死率的影响.方法 将637例经临床确诊的ST段上抬型、发病时间短于12 h的急性心肌梗死患者分为急诊PCI(105例)、溶栓(94例)、药物(348例)三组,依据logistic回归方程高危急性心肌梗死患者的P值,各组又分别分为高危、低危2个亚组.以Timi血流分级判断急诊PCI梗死相关冠状动脉(IRA)开通、血栓、慢复流、无复流情况,记录住院期间临床事件,4周后用二维超声心动图测定左心室射血分数(LVEF),统计各组及亚组28 d病死率.结果 急诊PCI组IRA开通率为100%,支架率为99.0%;高危与低危两个亚组术中冠脉内血栓发生率分别为25.03%、20.31%;慢复流发生率分别为30.12%、25.27%,无复流发生率分别为4.00%、0.00%(P均>0.05).临床事件发生率:出血:三组及亚组间比较差异无统计学意义(P>0.05).心力衰竭:药物组及亚组显著高于急诊PCI、溶栓组及亚组(P均<0.01).心绞痛;再梗死:溶栓组及亚组较急诊PCI、药物组及亚组高(P<0.05或P<0.01).急诊PCI组及亚组住院天数明显缩短(P<0.01).LVEF:药物组及亚组较急诊PCI、溶栓组及亚组下降(P均<0.05).三组28 d病死率分别为0%(0/105),7.46%(7/94),18.72%(82/438)(P<0.05或P<0.01);高危亚组病死率分别为0%(0/74)、10.45%(7/67)、26.03%(82/315)(P<0.05或P<0.01).结论 急诊PCI较尿激酶静脉溶栓及单纯药物治疗急性心肌梗死更能充分开通IRA,改善心功能,减少临床事件,缩短住院天数,可进一步降低高危急性心肌梗死病死率.
目的 探討急診經皮冠狀動脈介入治療(PCI)對高危急性心肌梗死患者近期病死率的影響.方法 將637例經臨床確診的ST段上抬型、髮病時間短于12 h的急性心肌梗死患者分為急診PCI(105例)、溶栓(94例)、藥物(348例)三組,依據logistic迴歸方程高危急性心肌梗死患者的P值,各組又分彆分為高危、低危2箇亞組.以Timi血流分級判斷急診PCI梗死相關冠狀動脈(IRA)開通、血栓、慢複流、無複流情況,記錄住院期間臨床事件,4週後用二維超聲心動圖測定左心室射血分數(LVEF),統計各組及亞組28 d病死率.結果 急診PCI組IRA開通率為100%,支架率為99.0%;高危與低危兩箇亞組術中冠脈內血栓髮生率分彆為25.03%、20.31%;慢複流髮生率分彆為30.12%、25.27%,無複流髮生率分彆為4.00%、0.00%(P均>0.05).臨床事件髮生率:齣血:三組及亞組間比較差異無統計學意義(P>0.05).心力衰竭:藥物組及亞組顯著高于急診PCI、溶栓組及亞組(P均<0.01).心絞痛;再梗死:溶栓組及亞組較急診PCI、藥物組及亞組高(P<0.05或P<0.01).急診PCI組及亞組住院天數明顯縮短(P<0.01).LVEF:藥物組及亞組較急診PCI、溶栓組及亞組下降(P均<0.05).三組28 d病死率分彆為0%(0/105),7.46%(7/94),18.72%(82/438)(P<0.05或P<0.01);高危亞組病死率分彆為0%(0/74)、10.45%(7/67)、26.03%(82/315)(P<0.05或P<0.01).結論 急診PCI較尿激酶靜脈溶栓及單純藥物治療急性心肌梗死更能充分開通IRA,改善心功能,減少臨床事件,縮短住院天數,可進一步降低高危急性心肌梗死病死率.
목적 탐토급진경피관상동맥개입치료(PCI)대고위급성심기경사환자근기병사솔적영향.방법 장637례경림상학진적ST단상태형、발병시간단우12 h적급성심기경사환자분위급진PCI(105례)、용전(94례)、약물(348례)삼조,의거logistic회귀방정고위급성심기경사환자적P치,각조우분별분위고위、저위2개아조.이Timi혈류분급판단급진PCI경사상관관상동맥(IRA)개통、혈전、만복류、무복류정황,기록주원기간림상사건,4주후용이유초성심동도측정좌심실사혈분수(LVEF),통계각조급아조28 d병사솔.결과 급진PCI조IRA개통솔위100%,지가솔위99.0%;고위여저위량개아조술중관맥내혈전발생솔분별위25.03%、20.31%;만복류발생솔분별위30.12%、25.27%,무복류발생솔분별위4.00%、0.00%(P균>0.05).림상사건발생솔:출혈:삼조급아조간비교차이무통계학의의(P>0.05).심력쇠갈:약물조급아조현저고우급진PCI、용전조급아조(P균<0.01).심교통;재경사:용전조급아조교급진PCI、약물조급아조고(P<0.05혹P<0.01).급진PCI조급아조주원천수명현축단(P<0.01).LVEF:약물조급아조교급진PCI、용전조급아조하강(P균<0.05).삼조28 d병사솔분별위0%(0/105),7.46%(7/94),18.72%(82/438)(P<0.05혹P<0.01);고위아조병사솔분별위0%(0/74)、10.45%(7/67)、26.03%(82/315)(P<0.05혹P<0.01).결론 급진PCI교뇨격매정맥용전급단순약물치료급성심기경사경능충분개통IRA,개선심공능,감소림상사건,축단주원천수,가진일보강저고위급성심기경사병사솔.
Objective To determine the influence on 28-day mortality for higher risk acute myocardial infarction(AMI) by primary PCI. Methods Six hundred and thirty-seven patients with ST segment elevation AMI,less than 12 hours onset were divided into three groups: primary PCI group; thrombolytic group;medical group.Based on P value of multivariate logistic regression analysis for higher risk AMI,three groups were divided into higher risk and lower risk subgroups. Primary PCI groups received acute coronary angiography, open, thrombolysis, slow reflow and no-reflow of IRA were evaluated by Timi flow grade; Clinic events in hospital were recorded;LVEF was measured with two-dimensional echocardiography after 4 weeks onset. Results The open rate was 100.00% in primary PCI group and 99.00% in stent rate. The coronary thrombolysis rate in operation is respectively 25.03%, 20.31% in higher risk subgroup and lower risk subgroup (P>0.05), and the slow reflow rate was respectively 25.27%, 30.12% (P>0.05). And the no-reflow rate were respectively 4.00%, 0.00% (P all>0.05). The clinical events including hemorrhage frequency: there were no difference in statistics among three groups and subgroups; Heart failure frequency: medical group and subgroup were higher than another two groups and subgroups(P<0.01); Angina pectoris frequency; Reocclusion frequency: thrombolytic group and subgroup were higher than another two groups and subgroups(P<0.05 or P<0.01). The days in hospital obviously reduce in primary PCI group and subgroup (P<0.05 or P<0.01). LVEF: medical group and subgroup were lower than another two groups and subgroups(P all<0.05). The mortality were respectively 0%, 7.46%, 18.72% for three groups (P<0.05 or P<0.01);is respectively 0%, 10.45%, 26.03% for three higher risk subgroups (P<0.05 or P<0.01). Conclusions Primary PCI in AMI could improve the reperfusion of IRA and left ventricular function and decrease heart events in hospital, shorten time in hospital, could decrease the mortality of higher risk AMI comparing with single intravenous UK thrombolytic and medical therapy.
