摘要
目的:探讨经尿激酶静脉溶栓加即刻准备的支架植入治疗急性心肌梗死(AMI)的临床疗效。方法:80例AMI患者中,直接冠脉支架植入20例(直接支架组),尿激酶静脉溶栓加即刻准备的支架植入30例(溶栓支架组),尿激酶静脉溶栓30例(溶栓组)。均行急诊冠状动脉造影,以Timi血流分级判断梗死相关冠状动脉(IRA)开通、血栓、慢复流情况;记录住院期间心脏事件;出院前用二维超声心动图测定左心室射血分数(LVEF)。结果:直接支架组IRA开通率为100％,溶栓支架组开通率为96.7％,溶栓开通率为46.7％(P<0.01);直接支架组与溶栓支架组术中冠脉内血栓发生率分别为25.0％,20.0％,P>0.05;慢复流发生率分别25.0％,30.0％,P>0.05;临床事件:出血、心力衰竭、心绞痛、再梗死,脑梗死,支架纽较溶栓组发病率低,但3组间统计学上无差异(P>0.05),住院天数明显短缩(P<0.01);3组病死率分别为0％,3.3％,6.7％(P<0.05);3组LVEF分别为(65.5±11.5)、(64.0±14.5)、(54.5±13.0)(P<0.05)。结论:直接支架植入或尿激酶静脉溶栓加即刘准备的支架植入较单纯尿激酶溶栓治疗惠性心肌梗死更能充分开通IRA,改善心功能,降低病死率。
Objective:Evaluate the efficacy of urokinase (UK) thrombolytic plus rescue PTCA/Stent in acute myocardial infarction( AMI). Methods: Among 80 patients with AMI, 20 received primary PTCA/Stent (primary PTCA/Stent group), 30 received intravenous UK thrombolytic plus rescue PTCA/Stent( thrombolytic and stent group), 30 received intravenous UK thrombolytic (thrombolytic group). All patients received acute coronary angiography.opening,thrombolysis and slow reflow of ischemic related artery(IRA) were evaluated by Timi flow grade and heart events in hospital were recorded. Left ventricular ejection fraction LVEF was measured with two-dimensional echocardiography before releasing. ResultS:The open rate is 100% in primary PTCA/Stent group and 96.7% in thrombolytic plus rescue stent group and 46.7% in thrombolytic group (P<0.01).The coronary thrombolysis rate in operation is respectively 25.0% , 20.0% in primary stent group and thrombolytic plus stent group ( P > 0.05), and the slow reflow rate is respectively 25.0% ,30.0% (P>0.05). The clinical events including hemorrhage,heart failure,angina pectoris.reocclusion,cerebral embolization in stent group are less than those in thromboly tic group, but there is no difference in statistics among three groups(P>0.05).Thedays in hospital obviously reduce (P<0.01). The mortality is respectively 0% ,3.3%, 6.7% for three groups and LVEF is respectively( 65.5±11.5) ,(64.0±14.5) ,(54.5±13.0) (P < 0.05). Conclusions: Primary PTCA/Stent and intravenous UR thromboytic plus rescue PTCA/Stent in AMI could improve the reperfusion of IRA and left ventricular function and decrease the mortality comparing with single intravenous UK thrombolytic therapy.
出处
《中国冶金工业医学杂志》
2004年第3期173-175,共3页
Chinese Medical Journal of Metallurgical industry
