摘要
目的比较急性ST段抬高性心肌梗死（STEMI）患者失去早期静脉溶栓时机后延迟急诊经皮冠状动脉介入术（PCI）治疗与早期溶栓成功后择期PCI对STEMI预后的影响，探讨延迟急诊PCI应用价值。方法102例STEMI患者被纳入回顾性分析，分为延迟急诊PCI组（31例）：急诊PCI开始距发病时间12—24h，入院后立即给予PCI治疗；溶栓PCI组（71例）：溶栓距发病时间≤6h，给予瑞替普酶溶栓和择期PCI。结果PCI后梗死相关动脉（IRA）的TIMI分级延迟急诊PCI组TIM10～1级3．23％、TIMI2～3级96．77％与溶栓PCI组TIM10～1级2．82％、TIMI2～3级97．18％比较差异无统计学意义（U=1．642，P=0．101）；发病3个月时，两组LVEDVI、LVESVI、LVEF比较差异均无统计学意义（P〉0．05）；治疗后延迟急诊PCI组严重心力衰竭、恶性心律失常等并发症较溶栓PCI组高，轻度出血则较溶栓PCI组低（P〈0．05）；梗死后心绞痛、发病3个月时心源性死亡比较差异无统计学意义（P〉0．05）。结论延迟急诊PCI及时开通IRA前向血流，在梗死后心绞痛、心源性死亡和3个月时心功能改善方面与早期溶栓成功后择期PCI有相似的结果。
Objective To compare the prognosis of ST elevation acute myocardial infarction （STEMI） of delayed emergency percutaneous coronary intervention （PCI） and elective PCI following the thrombolysis with reteplase in order to discuss the clinic value of the former. Methods 102 STEMI patients were reviewed retrospectively, and were divided into two groups. There were 31 cases in delayed emergency PCI group： PCI was done after 12 - 24 h attack , and 71 cases in elective PCI following thrombolysis group： thrombolysis with reteplase were offered within 6 h, then elective PCI. Results There were no statistical differences in the class of thrombolysis of myocardial infarction （ TIMI ） of infarction relative artery （IRA） , the results were 3.23% , 96.77% respectively in delayed emergency PCI group and 2.82% , 97.18% in elective PCI following thrombolysis group according to TIMI class 0 - 1, TIMI class 2 -3（ U = 1. 642, P =0. 101 ）. It was the same result of LVEDVI, LVESVI, LVEF indicators 3 months after attack between two groups（P 〉 0.05 ）. But there was statistical difference in the severe cardiac failure, malignancy arrhythmia between two groups （ P 〈 0.05 ）. Conclusion Delayed emergency PCI to remove the obstruction in the coronary artery is similar to elective PCI following thrombolysis in the incidence of composite end point events in STEMI.
出处
《中国急救医学》
CAS
CSCD
北大核心
2012年第8期692-695,共4页
Chinese Journal of Critical Care Medicine
