【摘要】 目的观察溶栓后冠状动脉介入治疗急性心肌梗死的疗效及安全性。方法将35例急性心肌梗死患者分为静脉溶栓后冠状动脉介入治疗组(A组)和直接冠脉介入治疗组(B组)。观察两组开始介入治疗时间、相关动脉血流分级、冠状动脉造影至球囊开通梗塞相关动脉时间、介入治疗时再灌注心律失常发生率、心肌梗死后心绞痛发生率、介入治疗前心功能分级、治疗后4周左心室射血分数及并发症。结果A组开始介入治疗时间较B组晚(6.63±0.93)hvs(5.28±0.67)h,P<0.05。A组冠状动脉造影时梗塞的相关动脉(TIMI)血流2～3级达55%,而B组为20%(P<0.05)。冠状动脉造影至球囊开通梗塞的相关动脉时间,在两组间无显著性差异(P>0.05)。A组再灌注心律失常发生率较B组低(P<0.05)。A组和B组心绞痛发生率无显著性差异(P>0.05)。介入治疗术后4周后左心室射血分数,在A组和B组间无明显性差异(P>0.05)。两组均无出血性并发症。结论急性心肌梗死后,如暂无条件进行急诊冠脉介入治疗的患者,尽早给予静脉溶栓;静脉溶栓后再行冠状动脉介入治疗急性心肌梗死仍是有效可行的。更多还原

【Abstract】 Objective To evaluate the effects and safety of the treatment on acute myocardial infarction (AMI) with post thrombolysis (PCI) Methods Thirty five patients with AMI was arranged to group A (post thrombolysis PCI) and group B (primary PCI)according to whether they had a treatment with thrombolysis before they had a PCI procedures And observed the time from AMI onset to the beginning of PCI percutaneous coronary intervention the TIMI grade in coronary angiography,the time from coronary angiography to the dilating of balloon,the rate of reperfusion induced arrhymias during PCI,the rate of angina pectoris post PCI,the Killips grade before and after PCI procedures,and evaluated the LVEF four weeks after PCI with two dimensional echocardiography assessment and all the complications The paraments and clinical features were analyzed retrospectively Results The time from AMI onset tothe beginning of PCI of group A was longer than that of group B (6 63±093 hours vs 5 28±0 67 hours,P< 0 05),the TIMI grade 2 and 3 of group A was better thn that of group B in coronary angiographic assessment (55%vs 20%,P< 0 05) There was no significant difference between group A and B in the time from coronary angiography to the dilating of balloon (17 5min vs 18 5min,P >0 05) and also the rate of angina pectoris post PCI of group A and B(P >0 05) But the rate of reperfusion induced arrhymias of group A was lower than that of group B (P< 0 05) There was no significant difference between group A and group B in Killips grade before PCI (P >0 05) and in LVEF four weeks after PCI assessed with echocardiography (0 62±0 04 vs 0 63±0 04,P >0 05) Both groups had no bleeding complications Conclusions The patients with AMI should treated with thrombolysis as ealier as possible;and the treatment of these patient with post thrombolysis PCI is effect and satety更多还原