论文部分内容阅读
目的:评价小剂量溶栓剂重组组织型纤溶酶原激活剂(50mgrt-PA)联合经皮冠状动脉介入(易化PCI)治疗ST段抬高急性心肌梗死(STEMI)的疗效和安全性。方法:215例STEMI患者,150例行直接PCI(直接PCI组),65例rt-PA50mg滴注30min后行PCI(易化PCI组),两组患者中心肌梗死溶栓试验(TIMI)0￣2级和3级但残余狭窄≥70%者(直接PCI组132例,易化PCI组52例)置入支架。比较两组PCI前后梗死相关动脉(IRA)开通率、支架置入率、ST段回落率、出院前左室射血分数、住院期间出血事件和主要不良心脏事件(MACE)。结果:易化PCI组首次冠状动脉造影IRA开通率和TIMI3级血流率显著高于直接PCI组(49.2%vs20.0%,P=0.00;27.7%vs14.0%,P=0.02),术后TIMI3级血流率、ST段回落率和出院前左室射血分数亦显著高于直接PCI组[96.9%vs88.0%,P=0.04;92.3%vs78.7%,P=0.01;(64.5±7.9)%vs(51.5±15.6)%,P<0.05],而两组支架置入率、住院期间出血事件和MACE无显著差异,且均未发生脑出血。结论:在STEMI治疗中,易化PCI可使缺血心肌获得尽早再灌注,为进一步血运重建赢得时间,提高了STEMI患者术后TIMI3级血流率、改善了心肌组织水平再灌注和心功能,且未明显增加住院期间出血事件和MACE,值得推广应用。
Objective: To evaluate the efficacy and safety of low-dose thrombolytic therapy of recombinant tissue plasminogen activator (50mgrt-PA) combined with percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute myocardial infarction (STEMI). Methods: A total of 215 patients with STEMI were enrolled in this study. 150 patients underwent direct PCI (direct PCI group) and 65 patients underwent rt-PA50mg drip infusion for 30min after PCI. The myocardial infarction thrombolysis test (TIMI) Patients in grades 2 and 3 but with residual stenosis ≥70% (132 in the direct PCI group and 52 in the facilitated PCI group) were placed in the stent. The incidence of infarction-related artery (IRA) opening, stent placement, ST-segment resolution, pre-discharge left ventricular ejection fraction, in-hospital bleeding and major adverse cardiac events (MACE) were compared between the two groups. Results: The first coronary angiography IRA rate and TIMI grade 3 blood flow rate in the PCI group were significantly higher than those in the direct PCI group (49.2% vs20.0%, P = 0.00; 27.7% vs14.0%, P = 0.02) TIMI3 grade blood flow rate, ST-segment resolution and left ventricular ejection fraction before discharge were also significantly higher than those in the direct PCI group [96.9% vs 88.0%, P = 0.04; 92.3% vs78.7%, P = 0.01; 64.5 ± 7.9)% vs (51.5 ± 15.6)%, P <0.05]. There was no significant difference in stent placement rate, MACE and hospital stay between the two groups, and no cerebral hemorrhage occurred. Conclusions: In the STEMI treatment, the facilitated PCI can make the ischemic myocardium reperfused as soon as possible, which can gain the time for further revascularization and increase the postoperative TIMI3 grade blood flow rate and improve the myocardial tissue reperfusion and cardiac function , And did not significantly increase the incidence of bleeding during hospitalization and MACE, it is worth promoting the application.