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目的:对比观察静脉溶栓、冠状动脉(冠脉)溶栓加补救/择期经皮冠状动脉介入术(PCI)、直接PCI对ST段抬高急性心肌梗死(STEMI)患者梗死相关动脉(IRA)血运重建的临床疗效。方法:选择108例STEMI患者,分为静脉溶栓组(静脉组,46例)、冠脉溶栓加补救/择期PCI组(冠脉组,28例)和直接PCI组(PCI组,34例)。静脉组给予尿激酶150万U;冠脉组行冠脉造影后,IRA内给予尿激酶50万U溶栓,再次造影,IRA未通者行补救PCI,再通者10d后行择期PCI;介入组行冠脉造影后,对IRA行直接PCI。4周后行心脏超声心动图检查了解各组患者的心脏功能。结果:静脉组、冠脉组、PCI组IRA再通率分别为60.9%、78.6%、100%,主要心血管事件发生率分别为26.9%、21.4%、18.8%,左室射血分数分别为(54.4±10.2)%、(56.2±9.6)%、(59.9±8.3)%。PCI组有1例发生支架内亚急性血栓形成。静脉组住院病死率为8.7%,脑卒中发生率为4.34%;冠脉组、PCI组均无一例发生住院死亡、脑卒中。结论:直接PCI效果佳、不良反应少,可作为治疗STEMI患者的首选。
Objective: To compare the effects of intravenous thrombolysis, coronary thrombolysis plus salvage / elective percutaneous coronary intervention (PCI) and direct PCI on infarct-related artery (IRA) in patients with ST-elevation acute myocardial infarction The clinical effect of revascularization. Methods: A total of 108 patients with STEMI were divided into three groups: intravenous thrombolysis group (46 cases), coronary thrombolysis plus rescue / elective PCI group (28 cases) and direct PCI group (34 cases ). Intravenous group given 1.5 million U of urokinase; Coronary angiography after coronary angiography, intrauterine IRU given 500000 U of urokinase thrombolysis, again angiography, IRA failed to rescue PCI, and then through 10d after elective PCI; intervention After coronary angiography, direct PCI was performed on the IRA. Cardiac echocardiography was performed 4 weeks later to understand the cardiac function of each group of patients. Results: The recanalization rates of IRA were 60.9%, 78.6% and 100% respectively in the venous group, coronary artery group and PCI group. The incidences of major cardiovascular events were 26.9%, 21.4% and 18.8% respectively. The left ventricular ejection fraction were (54.4 ± 10.2)%, (56.2 ± 9.6)% and (59.9 ± 8.3)%, respectively. One patient in the PCI group developed sub-stent thrombosis. In-hospital mortality was 8.7% in the intravenous group and 4.34% in the ischemic stroke group. In the coronary group and the PCI group, no hospital-resident death or stroke occurred. Conclusion: Direct PCI is effective and has few adverse reactions. It can be used as the first choice for treating STEMI patients.