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目的比较尿激酶静脉溶栓联合冠状动脉(冠脉)介入治疗(PCI)术与直接PCI术对急性心肌梗死(AMI)的有效性和安全性。方法64例首次ST段抬高AMI(STelevationmyocarialinfarc-tion,STEMI)患者随机分为直接PCI组(直接PCI治疗)和联合PCI组(在尿激酶静脉溶栓基础上联合直接PCI治疗)。PCI术治疗前后行冠脉造影、心电图检查,观察梗死相关血管(IRA)前向血流,测定心肌梗死溶栓治疗临床试验(TIMI)血流、TIMI心肌灌注分级(TMPG),计算冠脉造影灌注积分(APS)和心电图ST段回落程度,评估心外膜血管和心肌灌注情况,对两组患者介入术前IRA通畅率、住院期间出血并发症、急性缺血事件发生率及出院前左心室功能进行比较。用线性回归分析评价ST段回落程度与APS的相关性。结果PCI术前联合PCI组冠脉再通率显著高于直接PCI组(68.8%比37.6%,P<0.05),其中完全再通率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05);联合PCI组心肌再灌注率显著高于直接PCI组(71.9%比37.4%,P<0.01),其中完全心肌再灌注率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05)。PCI术后两组IRA的TIMI血流3级比较差异无统计学意义(90.6%比87.5%,P>0.05),但比较TMPG差异有统计学意义(93.8%比75.0%,P<0.05),其中TMP3级有明显差异(65.6%比37.5%,P<0.05);联合PCI组APS10~12分(心肌完全再灌注)与直接PCI组比较差异有统计学意义(P<0.01)。介入治疗后出院前联合PCI组的LVEF值明显大于直接PCI组。联合PCI组ST段完全回落比例明显高于直接PCI组。线性回归分析评价ST段回落程度与APS之间有显著相关性(相关系数r=0.961,P<0.001),住院期间两组均无死亡病例、严重出血及急性缺血事件发生。结论联合PCI术较直接PCI术可获得更好的IRA开通、心肌组织和微循环灌注及心功能的明显改善。APS结合TIMI血流分级和TMPG可较好地完整评价心外膜血管和心肌灌注情况,并与心电图ST段回落程度有显著相关性。
Objective To compare the efficacy and safety of intravenous thrombolytic therapy of urokinase with coronary artery (coronary artery) interventional therapy (PCI) and direct PCI in acute myocardial infarction (AMI). Methods Sixty-four patients with STEMI were randomly divided into direct PCI group (direct PCI) and PCI group (combined with intravenous thrombolysis on urokinase thrombolysis). Coronary angiography and electrocardiogram were performed before and after PCI. Infarct-related blood flow (IRA) was observed. TIMI flow, TIMI myocardial perfusion grading (TMPG), coronary angiography Perfusion score (APS) and electrocardiogram ST-segment regression to assess epicardial vascular and myocardial perfusion, the two groups of patients before interventional IRA patency rate, bleeding complications during hospitalization, the incidence of acute ischemic events and left ventricular discharge Function to compare. Linear regression analysis was used to evaluate the correlation between ST segment regression and APS. Results The rate of coronary recanalization in preoperation PCI group was significantly higher than that in direct PCI group (68.8% vs 37.6%, P <0.05). The complete recanalization rate was significantly different between the two groups (46.9% vs. 21.9 %, P <0.05). The myocardial reperfusion rate in PCI group was significantly higher than that in direct PCI group (71.9% vs 37.4%, P <0.01). The rate of complete myocardial reperfusion was significantly different between the two groups (46.9% % Than 21.9%, P <0.05). There was no significant difference in TIMI blood flow between the two groups after PCI (Grade 3, 90.6% vs 87.5%, P> 0.05), but the difference was statistically significant (93.8% vs 75.0%, P <0.05) (65.6% vs 37.5%, P <0.05). There was significant difference between the PCI group and the direct PCI group (P <0.01). The LVEF of the PCI group before PCI was significantly higher than that of the PCI group after PCI. The proportion of complete ST-segment decline in the combined PCI group was significantly higher than that in the direct PCI group. There was a significant correlation between the regression of ST segment and APS (r = 0.961, P <0.001) by linear regression analysis. There were no deaths, severe bleeding and acute ischemic events in both groups during hospitalization. Conclusion Compared with direct PCI, PCI can achieve better IRA opening, myocardial tissue and microcirculation perfusion and cardiac function significantly improved. APS combined with TIMI flow classification and TMPG can be a good and complete evaluation of epicardial vascular and myocardial perfusion, and with ECG ST segment regression was significantly correlated.