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目的探讨延迟急诊经皮冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI)的疗效及预后情况。方法 100例急性STEMI患者,按照PCI时机将其分为延迟组(45例)和溶栓组(55例)。延迟组患者发病12~24 h内被确诊,并立即行PCI治疗;溶栓组患者发病6 h内被确诊,并行溶栓药物治疗,择期行PCI治疗。对两组患者PCI治疗前后梗死相关动脉(IRA)情况[以心肌梗死溶栓试验(TIMI)分级评价]和并发症发生情况进行比较。结果 PCI治疗前IRA情况比较,延迟组TIMI 0~1级所占比例100.0%明显高于溶栓组61.8%,差异有统计学意义(P<0.05);PCI治疗后IRA情况比较,延迟组TIMI0~1级所占比例13.3%与溶栓组14.5%比较差异无统计学意义(P>0.05)。延迟组严重心力衰竭、恶性心律失常发生率26.7%、28.9%高于溶栓组9.1%、9.1%,差异均有统计学意义(P<0.05),两组梗死后心绞痛发生率比较差异无统计学意义(P>0.05)。结论延迟急诊PCI应用于急性STEMI的治疗中有助于及时疏通IRA,梗死后心绞痛发生率与早期溶栓成功再行PCI相当,不过术后严重心力衰竭、恶性心律失常的发生率较高。
Objective To investigate the efficacy and prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods One hundred patients with acute STEMI were divided into delayed group (45 cases) and thrombolytic group (55 cases) according to the timing of PCI. Patients in the delayed group were diagnosed within 12 to 24 hours of onset and were treated with PCI immediately. Patients in the thrombolytic group were diagnosed within 6 hours of onset of symptoms and were treated with thrombolytic drugs and were treated with PCI. The infarct-related artery (IRA) status [graded by myocardial infarction thrombolysis test (TIMI)] and the incidence of complications before and after PCI were compared between the two groups. Results Compared with IRA before PCI, the proportion of TIMI grade 0 ~ 1 in delay group was significantly higher than that in thrombolysis group (61.0%) (P <0.05), and the difference of IRA between PCI group and TIMI0 ~ 1 Grade 13.3% and thrombolysis group 14.5% difference was not statistically significant (P> 0.05). Delayed group, severe heart failure, the incidence of malignant arrhythmia 26.7%, 28.9% higher than the thrombolytic group 9.1%, 9.1%, the difference was statistically significant (P <0.05), the incidence of post-infarction angina pectoris was no significant difference (P> 0.05). Conclusions Delayed emergency PCI can be used to promptly clear the IRA during the treatment of acute STEMI. The incidence of post-infarction angina pectoris is similar to the success rate of early thrombolysis followed by PCI. However, the incidence of severe heart failure and malignant arrhythmia after operation is relatively high.