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目的探讨长沙地区急性心肌梗死不同院前心肌再灌注方案的实际执行状况和效果。方法本研究为非随机、前瞻性试验。入选的急性心肌梗死病例被分为尿激酶(UK)组、重组组织型纤溶酶原激活剂(r-tPA)组、经皮冠状动脉介入治疗(PCI)组和非再灌注组,非再灌注组的病例予以低分子肝素、阿司匹林治疗,观察不同方案的实际实施状况及近期疗效、并发症和费用-效果比。结果①106例AMI病人,87例施行了再灌注治疗(82%),急诊PCI组24例(23%),r-tPA组27例(25%),UK组36例(34%);非再灌注19例(18%)。②再通率为UK组61.3%,r-tPA组81.5%,PCI组95.8%;入院至开始再灌注时间为UK组(38.52±16.21)min,r-tPA组(46.23±17.13)min,PCI组(98.47±20.42)min;入院至再通时间为UK组(73.21±11.34)min,r-tPA组(122.12±23.46)min,PCI组(132.73±13.67)min。③住院期心绞痛发生率,再发心肌梗死率,心衰发生率,病死率在PCI组优于r-tPA组,r-tPA组优于UK组,三组均显著低于非再灌注组。④费用-再通率比为PCI组33893.16元,r-tPA组16717.53元,UK组3037.52元。结论在AMI的实际临床治疗中,大部分病人接受了急诊再灌注治疗。UK方案仍是采用最多的方案,可以在较短时间内实现IRA再通,且费用-效果比低,但再通率偏低,近期效果不满意。急诊PCI的再通率和近期临床效果最佳,但容易受多因素影响而耽误开始再灌注治疗的时间,且费用-效果比高。r-tPA的再通率、近期临床效果均明显高于UK,恢复IRA再通的时间与PCI接近,费用-效果比显著低于急诊PCI,是个比较理想可行的AMI急诊再灌注方案。
Objective To investigate the actual implementation status and effect of different pre-hospital myocardial reperfusion programs on acute myocardial infarction in Changsha area. Methods This study was a nonrandomized, prospective trial. Selected cases of acute myocardial infarction were divided into urokinase (UK) group, recombinant tissue-type plasminogen activator (r-tPA) group, percutaneous coronary intervention (PCI) group and non-reperfusion group, The patients in the perfusion group were treated with low molecular weight heparin and aspirin. The actual implementation status and the short-term curative effect, complications and cost-effectiveness were observed. Results In 106 patients with AMI, 87 patients underwent reperfusion therapy (82%), 24 (23%) patients in the emergency PCI group, 27 patients (25%) in the r-tPA group and 36 patients (34%) in the UK group Perfusion in 19 cases (18%). The reperfusion rates were 61.3% in the UK group, 81.5% in the r-tPA group and 95.8% in the PCI group. The duration of the reperfusion was 38.52 ± 16.21 min in the UK group and 46.23 ± 17.13 min in the r-tPA group, Group (98.47 ± 20.42) min. The duration of admission to recanalization was 73.21 ± 11.34 min in UK group, 122.12 ± 23.46 min in r-tPA group and 132.73 ± 13.67 min in PCI group. The incidence of angina pectoris, recurrence of myocardial infarction, heart failure and mortality in hospitalized patients were superior to those in r-tPA group and r-tPA group. The three groups were significantly lower than non-reperfusion group. ④ cost - the recanalization rate for PCI group 33893.16 yuan, r-tPA group 16717.53 yuan, UK group 3037.52 yuan. Conclusion In the actual clinical treatment of AMI, most of the patients received emergency reperfusion therapy. UK program is still the most widely used program, IRA recanalization can be achieved in a relatively short period of time, and the cost-effectiveness ratio is low, but the low pass rate, the recent unsatisfactory results. Emergency PCI re-pass rate and the best clinical results in the near future, but easily affected by many factors and delay the start of reperfusion treatment time, and cost - effective than high. The recanalization rate of r-tPA and its recent clinical effect were significantly higher than that of UK. The time to resume IRA recanalization was close to that of PCI, and the cost-effect ratio was significantly lower than that of emergency PCI. This is an ideal and feasible AMI emergency reperfusion regimen.