【摘要】 目的探讨急性ST段抬高型心肌梗死(STEMI)紧急血运重建的临床疗效.方法 308例AMI患者分为紧急血运重建治疗组157例和药物治疗组151例.对所有患者随访4~88个月,平均随访(45±26)个月.观察住院期间和随访期间的心脏不良事件和超声心动图的变化,并利用QRS计分评估梗死范围的变化.结果 1)紧急血运重建组平均住院时间为(13.8±9.7)d,显著少于内科药物治疗组(19.8±8.9)d,P<0.05;2)延迟血运重建组的复合终点事件发生率显著少于药物治疗组,P<0.05,差异有统计学意义;3)随访期间,延迟血运重建组的心力衰竭及复合终点事件的发生率显著低于药物治疗组,P<0.05;4)超声心动图随访结果示:紧急血运重建组的LVEF显著高于药物治疗组,差异有统计学意义,P<0.05,紧急血运重建组的LVDd显著小于药物治疗组,P<0.05;5)紧急血运重建组的心肌梗死范围回缩率(0.386±0.120)显著大于药物治疗组(0.273±0.096),P<0.05.结论紧急血运重建能减少住院期间和随访期间的心脏事件发生率,改善左室功能,使心肌梗死面积缩小,并改善AMI患者的预后.更多还原

【Abstract】 Objective To evaluate the clinical effects on acute ST-elevation myocardial infarction(STEMI)treated with emergency revascularization.Method Among 308 patients with STEMI,157 patients were treated with emergency revascularization(emergency revascularization group)and 151 patients were treated with medical therapy(medical therapy group).All patients were investigated during in-hospital and 4~88 months follow-up regarding major adverse cardiac events(MACE)and the cardiac structure and function by echocardiography and infarct size estimated by QRS point system.Results 1)Average hospital stay(13.8±9.7d)in emergency revascularization group were significantly shorter than those of medical therapy group(19.8±8.9d)(P<0.05).2)The rate of in-hospital MACE in emergency revascularization group were significantly less than that of medical therapy(P<0.05).3)In follow-up period,compared with medical therapy group,emergency revascularization decreased incidence of heart failure and MACE(P<0.05).4)LVEF in emergency revascularization group was significantly larger than those of medical therapy(P<0.05).LVDd and LAD in emergency revascularization group were significantly less than those in medical therapy group.5)MI size(0.386±0.120)in emergency revascularization group was greater than that of medical group(0.273±0.096),P<0.05.Conclusion The emergency revascularization may shorten in-hospital stay and decrease the rate of MACE during hospitalization and follow-up and infarct size,improve left ventricular function and prognosis.更多还原