重庆医学
重慶醫學
중경의학
CHONGQING MEDICAL JOURNAL
2014年
33期
4479-4480,4484
,共3页
ST段抬高型心肌梗死%急诊经皮冠脉介入术%溶栓
ST段抬高型心肌梗死%急診經皮冠脈介入術%溶栓
ST단태고형심기경사%급진경피관맥개입술%용전
ST elevation acute myocardial infarction%percutaneous coronary intervention%thrombolysis
目的：探讨采用延迟急诊经皮冠状动脉介入术（PCI）治疗失去早期经静脉溶栓时机的ST段抬高型心肌梗死（STE‐MI）与早期静脉溶栓成功并择期行PCI在预后中的差别。方法选取该院诊治的STEMI患者120例，并根据其PCI时机分为溶栓组和延迟组：溶栓组82例，溶栓时间距发病时间小于或等于6 h ，予瑞替普酶静脉溶栓及择期行PCI；延迟组38例，入院后即予PCI ，PCI时间距发病12～24 h。记录患者各阶段的临床症状及心电图改变，判断PCI前后梗死相关动脉（IRA ）的心肌梗死溶栓试验（TIMI）分级，比较两组患者的预后。结果 PCI后，溶栓组的 TIMI分级：0～1级为4．88％（4/82），2～3级为95．12％（78/82）；延迟组TIMI分级：0～1级为5．26％（2/38），2～3级为94．74％（36/38），两组比较差异无统计学意义（P＞0．05）。发病后3个月，两组间左心室收缩末期容积指数（LVESVI）、左心室舒张末容积指数（LVEDVI）及左室射血分数（LEVF）比较，差异无统计学意义（P＞0．05）。经治疗后延迟组严重心力衰竭发生率及恶性心律失常发生率均高于溶栓组（P＜0．05），两组间梗死后心绞痛及发病3个月后心源性病死率比较，差异无统计学意义（P＞0．05）。结论延迟急诊 PCI可尽早疏通IRA ，在心源性死亡、心肌梗死后心绞痛及发病后3个月心功能改善等方面，与发病早期溶栓成功并择期PCI无明显差异。
目的：探討採用延遲急診經皮冠狀動脈介入術（PCI）治療失去早期經靜脈溶栓時機的ST段抬高型心肌梗死（STE‐MI）與早期靜脈溶栓成功併擇期行PCI在預後中的差彆。方法選取該院診治的STEMI患者120例，併根據其PCI時機分為溶栓組和延遲組：溶栓組82例，溶栓時間距髮病時間小于或等于6 h ，予瑞替普酶靜脈溶栓及擇期行PCI；延遲組38例，入院後即予PCI ，PCI時間距髮病12～24 h。記錄患者各階段的臨床癥狀及心電圖改變，判斷PCI前後梗死相關動脈（IRA ）的心肌梗死溶栓試驗（TIMI）分級，比較兩組患者的預後。結果 PCI後，溶栓組的 TIMI分級：0～1級為4．88％（4/82），2～3級為95．12％（78/82）；延遲組TIMI分級：0～1級為5．26％（2/38），2～3級為94．74％（36/38），兩組比較差異無統計學意義（P＞0．05）。髮病後3箇月，兩組間左心室收縮末期容積指數（LVESVI）、左心室舒張末容積指數（LVEDVI）及左室射血分數（LEVF）比較，差異無統計學意義（P＞0．05）。經治療後延遲組嚴重心力衰竭髮生率及噁性心律失常髮生率均高于溶栓組（P＜0．05），兩組間梗死後心絞痛及髮病3箇月後心源性病死率比較，差異無統計學意義（P＞0．05）。結論延遲急診 PCI可儘早疏通IRA ，在心源性死亡、心肌梗死後心絞痛及髮病後3箇月心功能改善等方麵，與髮病早期溶栓成功併擇期PCI無明顯差異。
목적：탐토채용연지급진경피관상동맥개입술（PCI）치료실거조기경정맥용전시궤적ST단태고형심기경사（STE‐MI）여조기정맥용전성공병택기행PCI재예후중적차별。방법선취해원진치적STEMI환자120례，병근거기PCI시궤분위용전조화연지조：용전조82례，용전시간거발병시간소우혹등우6 h ，여서체보매정맥용전급택기행PCI；연지조38례，입원후즉여PCI ，PCI시간거발병12～24 h。기록환자각계단적림상증상급심전도개변，판단PCI전후경사상관동맥（IRA ）적심기경사용전시험（TIMI）분급，비교량조환자적예후。결과 PCI후，용전조적 TIMI분급：0～1급위4．88％（4/82），2～3급위95．12％（78/82）；연지조TIMI분급：0～1급위5．26％（2/38），2～3급위94．74％（36/38），량조비교차이무통계학의의（P＞0．05）。발병후3개월，량조간좌심실수축말기용적지수（LVESVI）、좌심실서장말용적지수（LVEDVI）급좌실사혈분수（LEVF）비교，차이무통계학의의（P＞0．05）。경치료후연지조엄중심력쇠갈발생솔급악성심률실상발생솔균고우용전조（P＜0．05），량조간경사후심교통급발병3개월후심원성병사솔비교，차이무통계학의의（P＞0．05）。결론연지급진 PCI가진조소통IRA ，재심원성사망、심기경사후심교통급발병후3개월심공능개선등방면，여발병조기용전성공병택기PCI무명현차이。
Objective To compare the prognosis of ST elevation acute myocardial infarction(STEMI) of delayed emergency per‐cutaneous coronary intervention(PCI) and elective PCI following the thrombolysis with reteplase ,and to investigate the clinic value of the former solution .Methods One hundred and twenty STEMI patients were reviewed retrospectively and were divided into 2 groups according to PCI .Eighty two cases were divided into emergency group :thrombolysis with reteplase offered within 6h was followed by elective PCI;38 cases were divided into delayed group:PCI was done after 12-24 h after ATEMI′occurring .The clini‐cal features and CTG changes were recorded ,TIMI class of IRA was conducted before and after PCI ,and their prognosis were com‐pared .Results There was no statistical differences in the class of thrombolysis of myocardial infarction(Class 0 -1 ,2 -3) of in‐farction relative artery (IRA)(4 .88% ,95 .12% vs .5 .26% ,94 .74% ) after PCI(P>0 .05) .There was no statistical difference in LVEF ,LVEDVI and LVESVI 3 months after attack between two groups(P>0 .05) .There was statistical difference in the severe cardiac failure and malignancy arrhythmia between two groups(P<0 .05) ,while no statistical difference exist in angina after infarc‐tion as well as cardiac mortality after attack between two groups(P>0 .05) .Conclusion Delayed emergency PCI to remove the ob‐struction in the coronary artery has no significant difference with elective PCI following thrombolysis in the incidence of composite end point events in STEMI .
