急诊介入与溶栓治疗对急性心肌梗死疗效的比较.docVIP

急诊介入与溶栓治疗对急性心肌梗死疗效的比较 　　作者：葛晓娟，关振龙 作者单位：辽宁省阜新市中心医院心内科，辽宁 阜新　123000 　　【摘要】 目的：比较经皮冠状动脉介入治疗(PCI)与静脉溶栓治疗对急性心肌梗死(AMI)的疗效。方法：2006年1月至2010年6月间收治的60例AMI病人被分为：PCI组(30例)，静脉溶栓组(30例);比较两组的ST回落情况，再通率，死亡率，主要不良心血管事件(MACE)发生率和心功能情况。结果：与静脉溶栓组比较，PCI组ST回落明显，ST仍抬高的水平明显较低(0.17±0.09)mV比(0.03±0.02)mV;与静脉溶栓组比较，PCI组30d内死亡率(10%比3.3%)，MACE发生率(23.3%比10%)明显降低，梗死相关血管再通率(53.3%比96.7%)明显提高，心功能明显改善[左室舒张末内径(51.8±5.8)mm比(45.7±6.6)mm，左室射血分数(45.2±7.7)%比(52.1±5.5)%]，P均0.01。结论：经皮冠状动脉介入治疗能及时有效地开通梗死相关动脉挽救濒死的心肌，改善心功能，降低死亡率，是治疗急性心肌梗死的首选方法。 　　【关键词】 心肌梗塞,血管成形术,经腔,经皮冠状动脉;血栓溶解疗法 　　Abstract：Objective： To compare therapeutic effects of percutaneous coronary intervention (PCI) and intravenous thrombolytic therapy on acute myocardial infarction (AMI). Methods：A total of 60 AMI patients admitted from Jan 2006 to Jun 2010 were divided into PCI group (n=30) and intravenous thrombolysis group (n=30). Comparison were performed on regression of ST segment(∑ST)， recanalization rate， mortality rate， incidence rate of major adverse cardiovascular events (MACE)and cardiac function in the two groups. Results：Regression of ST segment in PCI group was significantly more than that of intravenous thrombolysis group，remain ∑ST[(0.03±0.02) vs. (0.17±0.09)]; Compared with intravenous thrombolysis group， there were significant decrease in mortality rate within 30 d (10% vs. 3.3%) and MACE incidence rate (23.3% vs. 10%)， significant increase in recanalization rate of infarct-related artery (53.3% vs. 96.7%) and significant improvements in cardiac function [left ventricular end-diastolic dimension： (51.8±5.8) mm vs. (45.7±6.6) mm， left ventricular ejection fraction： (45.2±7.7)% vs. (52.1±5.5)%]in PCI group， P0.01 all. Conclusion： Percutaneous coronary intervention can effectively open infarct-related artery in time， save agonal myocardium， improve cardiac function and lower mortality rate. Its a preferred method for treatment of acute myocardial infarction. 　　Key words： Myocardial infarction; Angioplasty， transluminal， p