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目的:探讨急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)伴右束支传导阻滞患者的临床意义。方法:分析急诊PCI组(23例)和静脉溶栓疗法组(对照组26例)的血清肌酸激酶同功酶(CK-MB)峰值、ST段抬高总和和治疗开始后90min ST段回落程度、住院期间心脏事件发生率、出院前左室射血分数等指标。结果:23例急诊PCI组血清CK-MB峰值(396±126U/L)明显低于对照组(793±139 u/L).两组差异有显著意义(P<0.01)。治疗开始后90 min ST段回落程度急诊PCI组大于对照组(62.0%vs 44.0%,P<0.05)。急诊PCI组住院期间心脏事件发生率低于对照组(8.7%vs 26.9%,P<0.05)。出院前左室射血分数急诊PCI组大于对照组(分别为0.58±0.09和0.48±0.10,P<0.05)。结论:对AMI伴右束支传导阻滞患者急诊PCI优于静脉溶栓疗法。
Objective: To investigate the clinical significance of emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) with right bundle branch block. Methods: Serum creatine kinase isoenzyme (CK-MB) peak value was analyzed in the emergency PCI group (23 cases) and intravenous thrombolytic therapy group (26 cases in the control group). The ST segment elevation and the ST segment depression 90 minutes after the start of treatment The degree of cardiac events during hospitalization, pre-discharge left ventricular ejection fraction and other indicators. Results: The serum CK-MB peak value (396 ± 126U / L) in 23 emergency PCI groups was significantly lower than that in the control group (793 ± 139u / L), with significant difference between the two groups (P <0.01). The level of ST-segment drop 90 min after the start of treatment in the emergency PCI group was significantly higher than that in the control group (62.0% vs 44.0%, P <0.05). The incidence of cardiac events during the hospitalization of emergency PCI group was lower than that of the control group (8.7% vs 26.9%, P <0.05). Pre-discharge left ventricular ejection fraction was higher in the PCI group than in the control group (0.58 ± 0.09 and 0.48 ± 0.10, P <0.05, respectively). Conclusions: PCI is superior to intravenous thrombolysis in AMI patients with right bundle branch block.