【摘要】 目的:比较不同急性ST段抬高型心肌梗死(STEMI)患者静脉溶栓治疗、溶栓成功后延迟经皮冠状动脉介入(PCI)治疗、直接PCI(PPCI)治疗的临床疗效及近期预后。方法:入选符合入组标准的218例STEMI患者。根据患者就诊时间及治疗的实际情况分组:A组即PPCI治疗(90例);B组即只进行静脉溶栓治疗(78例),将发病3 h内溶栓的患者分为B1组(30例),超过3 h分为B2组(48例);C组即溶栓成功后延迟PCI治疗组(50例)。支架及用药方法:A组、C组患者罪犯血管是PCI治疗的唯一目标,不限制支架的应用与选择。3组患者治疗方案均遵循STEMI治疗指南。随访指标:218例患者均在术后30 d接受门诊随访。比较住院和随访期间的心脏事件(MACE事件)、复合终点事件和心脏彩超[左室射血分数(LVEF)、左室舒张末径(LVEDD)]变化。结果:218例患者均进入结果分析。(1)各组患者间基线资料和临床资料比较差异均无统计学意义,各组间具有可比性;(2)随访期间MACE事件及复合终点事件发生率:A组低于B2组、C组,差异有统计学意义(P<0.05)。(3)随访期间A组LVEF高于B2组、C组,C组LVEF高于B2组;A组LVEDD低于B2组、C组,C组LVEDD低于B2组,比较差异有统计学意义(P<0.05)。结论:直接PCI是STEMI患者最有效的再灌注治疗方法;发病3 h内的患者,溶栓治疗的即刻效果及30 d预后不劣于直接PCI。溶栓治疗并不是STEMI患者的治疗终点。更多还原

【Abstract】 Objective: To compare the clinical effectiveness and prognosis of different acute ST elevated myocardial infarction(STEMI)patients by intravenous thrombolytic therapy, percutaneous coronary intervention(PCI) treatment after thrombolytic and direct PCI(PPCI)treatment. Methods: Two hundred and eighteen STEMI patients were selected. Basing on the treatment time and condition, the patients were divided into three groups. Group A was treated with PPCI(90 cases), Group B with intravenous thrombolytic therapy(78 cases), and were further divided into B1 group(30 cases) where patients were thrombolytic within 3 h and B2 group(48 cases) with more than 3 h. Group C(50 cases) were treated with delayed PCI after thrombolytic. Stent and treatment methods: Arteries of patients in Group A and C were the only goal for PCI treatment, without limiting the application and selection of stent. The treatment scheme of 3 groups had all followed STEMI guidelines. Follow-up indicators included MACE, composite end point event, LVEF and LVEDD. All of postoperative patients accepted the outpatient follow-up within 30 days. Differences between hospitalization and follow-up period in MACE, composite end point event, LVEF and LVEDD indicators were compared. Results: The result analysis included all patients.(1)There were no statistical differences between the groups in terms of the patients’ baseline data and clinical data.(2)The incidence of MACE and composite end point event during the follow-up period: Group A was lower than Group B2 and Group C. The difference was statistically significant(P <0.05).(3)During the follow-up period, the LVEF indicator for Group A was higher than Group B2 and Group C, the LVEF indicator for Group C was higher than Group B2, the LVEDD indicator for Group A was lower than Group B2 and Group C, and the LVEDD indicator for Group C was lower than Group B2. The difference was statistically significant(P <0.05). Conclusion: Direct PCI may be the most effective method of reperfusion therapy for patients with STEMI. As for the patients within 3 hours, thrombolytic therapy method is not inferior to the direct PCI in terms of immediate effect and prognosis of 30 days. As for the patients with STEMI, thrombolytic therapy may not be the final answer.更多还原