【摘要】 目的比较直接经皮冠状动脉腔内成形术（ＰＴＣＡ）与药物溶栓治疗急性心肌梗塞（ＡＭＩ）患者住院期间的临床效果。方法在１０９例ＡＭＩ患者中，４５例患者接受直接ＰＴＣＡ治疗，６４例患者接受药物溶栓治疗。结果溶栓组梗塞相关血管（ＩＲＡ）再通的患者有４８例，再通率为７５％；直接ＰＴＣＡ组ＩＲＡ成功开通的患者有４４例，成功率为９７．８％。住院期间左室射血分数（ＥＦ）溶栓组为５４．１±１３．２，直接ＰＴＣＡ组为６４．２±１０．１，差异有显著性（Ｐ＜０．０５）；病死率分别为６．３％和２．２％，两组间差异无显著性（Ｐ＞０．０５）。进一步分析溶栓再通组与直接ＰＴＣＡ成功组的临床疗效，前者因再闭塞或缺血发作行择期ＰＴＣＡ的比率明显高于直接ＰＴＣＡ组（２７．１％ｖｓ０；Ｐ＜０．０５），但直接ＰＴＣＡ组左室ＥＦ仍显著高于溶栓再通组（６４．８±９．８ｖｓ５５．９±１２．６Ｐ＜０．０５）。住院期间再发梗塞，心肌缺血事件和心力衰竭例数溶栓再通组都有增加的趋势，但差异无显著性（Ｐ＞０．０５）。结论直接ＰＴＣＡ与溶栓治疗ＡＭＩ患者，前者可使ＩＲＡ充分有效地开通，能更好地改善患者心功能更多还原

【Abstract】 Objective To compare the clinical efficacy of primary angioplasty with thrombolytic therapy in the treatment of acute myocardial infarction (AMI) during hospitalization. Methods One hundred and nine consecutive patients with a first AMI underwent either intravenous thrombolytic therapy (64 patients) or primary angioplasty (45 patients). Cardiac function (left ventricular ejection fraction, LVEF) was assessed during hospitalization by echocardiography.Results The recanalizing rate of infarct related artery (IRA) in patients with thrombolytic therapy was 75%, while in those with primary angioplasty was 97.8%. There were no significant differences in age, risk factors, time from onset of symptom to hospital presentation and infarct location between the two but apparent differences were found in LVEF (54.1±13.24 vs 64.17±10.12, P < 0.05).In particular, in those patients with successful patency of IRA, the LVEF in the latter was still higher than that of the former (55.9± 12.6 vs 64.8±9.8; P <0.05).Conclusions The present study showed that in a highly selected cohort with successful IRA recanalization, PTCA is more effective than thrombolytic therapy in preserving cardiac function after AMI.更多还原