摘要
目的：了解溶栓治疗后冠状动脉再通的临床标准的准确性。方法：以冠状动脉造影为标准，对冠状动脉再通的临床标准进行双盲诊断试验研究。７３例急性心肌梗死患者在静脉溶栓治疗后２小时内接受冠状动脉造影检查。结果：以《中华心血管病杂志》编委会推荐的参考方案的标准判断４０例再通，３３例未通；以冠状动脉造影判断４４例再通，２９例未通。参考方案标准的敏感度为６８．２％，特异度为６５．５％，临床准确度为６７．１％。结论：目前临床沿用的参考方案的标准是较好的判断标准。试图改变其中某些标准的方法不能增加其敏感度和准确度。在对假阳性及假阴性患者进行分析时发现：ＳＴ段在溶栓治疗后２小时内不能迅速下降是影响其临床准确度的原因；不同类型心律失常预报临床再通的价值不同，且与心肌梗死部位有关。
Objective:In order to know the accuracy of clinical criterion of coronary reperfusion after thrombolytic therapy. Methods:A double blind clinical research of noninvasive criterion of coronary reperfusion after thrombolytic therapy and coronary angiography was carried out in patients with acute myocardial infarction (AMI).The coronary angiography was performed within 2 h after intravenous thrombolytic therapy and was taken as reference. Results:Clinical criterion of coronary reperfusion after thrombolytic therapy (CCCRTT) showed 40 patients reperfusion and 33 patients non reperfusion,while coronary angiography showed 44 patients reperfusion and 29 patients nonreperfusion.Therefore,CCCRTT had a sensitivity of 68 2%,specificity of 65 5% and clinical accuracy of 67 1% in diagnosing coronary reperfusion of AMI. Conclusions:CCCRTT is rather a good criterion in diagnosing coronary reperfusion up to date.Any attempt made to change the criterion did not increase the sensitivity and clinical accuracy.In analyzing pseudo negative and pseudo positive cases,the fact that ST segment does not decrease rapidly within 2 h after thrombolytic therapy is the main cause of the clinical inaccuracy.Various types of arrhythmia have different significance in predicting coronary reperfusion,which is also related to the area of AMI.
出处
《中国循环杂志》
CSCD
北大核心
1997年第1期5-7,共3页
Chinese Circulation Journal
关键词
心肌梗塞
溶栓术
冠状动脉造影
Acute myocardial infarction
Thrombolytic therapy
Reperfusion
Coronary angiography
