CAJ | 학술논문

目的：观察ST段抬高心肌梗死（STEMI）患者溶栓治疗时机与预后的关系。方法纳入2008年7月~2012年6月广东省吴川市人民医院STEMI患者229例，所有患者均采用溶栓治疗。根据患者发病至溶栓时间，分为4个治疗时间段，发病至溶栓＜3h为第1组（n=67），（3～6）h为第2组（n=96），（6～12）h为第3组（n=45），（12～24）h为第4组（n=21）。观察各组溶栓再通率（包括胸痛缓解、心电图ST段回落和心肌酶CK-MB峰值提前）以及30天内全因死亡率。结果随着发病至溶栓时间的延长，溶栓再通率不断下降[第1组：82.09%（55/67），第2组：73.96%（71/96），第3组：42.22%（19/45），第4组：35.00%（7/20）]，30天死亡率不断升高[第1组：5.97%（4/67）；第2组：9.38%（9/96）；第3组：11.11%（5/45），第4组：15.00%（3/20）]，各组之间均有统计学差异（P＜0.05）。结论溶栓治疗时机越早则患者预后越好，超过12小时的患者仍可进行溶栓治疗，并能够改善预后。
목적：관찰ST단태고심기경사（STEMI）환자용전치료시궤여예후적관계。방법납입2008년7월~2012년6월광동성오천시인민의원STEMI환자229례，소유환자균채용용전치료。근거환자발병지용전시간，분위4개치료시간단，발병지용전＜3h위제1조（n=67），（3～6）h위제2조（n=96），（6～12）h위제3조（n=45），（12～24）h위제4조（n=21）。관찰각조용전재통솔（포괄흉통완해、심전도ST단회락화심기매CK-MB봉치제전）이급30천내전인사망솔。결과수착발병지용전시간적연장，용전재통솔불단하강[제1조：82.09%（55/67），제2조：73.96%（71/96），제3조：42.22%（19/45），제4조：35.00%（7/20）]，30천사망솔불단승고[제1조：5.97%（4/67）；제2조：9.38%（9/96）；제3조：11.11%（5/45），제4조：15.00%（3/20）]，각조지간균유통계학차이（P＜0.05）。결론용전치료시궤월조칙환자예후월호，초과12소시적환자잉가진행용전치료，병능구개선예후。
Objective To observe the relationship between opportunity and prognosis of thrombolytic treatment of ST-segment elevation myocardial infarction (STEMI).Methods The patients diagnosed as STEMI (n=229) were chosen from People’s Hospital of Wuchuan City of Guangdong Province from Jul. 2008 to Jun. 2012. All patients were given thrombolytic treatment, and the treatment time was divided into 4 groups according to the periods from disease onset time to thrombolytic time. The period less than 3 h was taken as group 1 (n=67), (3-6) h as group 2 (n=96), (6-12) h as group 3 (n=45) and (12-24) h as group 4 (n=21). The recanalization rate (including chest pain relieving, ST-segment falling back and peak of myocardial enzyme CK-MB advancing) and all-cause mortality within 30 d were observed in all groups.Results As the prolong of the periods from disease onset time to thrombolytic time, recanalization rate decreased continuously [group 1: 82.09% (55/67), group 2: 73.96% (71/96), group 3: 42.22% (19/45) and group 4: 35.00% (7/20)], and all-cause mortality within 30 d increased continuously [group 1: 5.97% (4/67), group 2: 9.38% (9/96), group 3: 11.11% (5/45) and group 4: 15.00% (3/20)]. There was statistical difference among all groups (P<0.05).Conclusion If the time of thrombolytic treatment is earlier, the prognosis will be better in the patients with STEMI. The patients with disease onset time over 12 h still can be given thrombolytic treatment and the prognosis can be improved.