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目的:探讨溶栓后联合经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心肌组织灌注的影响。方法:采用回顾性分析首次AMI患者94例,发病时间均在12 h以内。36例接受溶栓联合PCI治疗,58例接受直接PCI治疗,并于PCI后测定心肌组织灌注分级,了解二者对AMI患者心肌组织灌注的影响。结果:2组患者自发病至PCI时间比较无明显差异;首次冠状动脉造影显示:溶栓联合PCI组PCI前梗死相关动脉TIMI 3 级血流者明显较直接PCI组增多;溶栓联合PCI组介入治疗成功率高,且术后TIMI 3级血流者、PCI后心肌组织灌注TMP 2级以上者均明显多于直接PCI组;2组比较出血并发症发生率无明显差异。结论:溶栓联合PCI治疗AMI安全有效,早期再通率高,心肌微循环灌注好,心肌梗死面积小,更有利于保护心室功能,且不增加出血并发症。
Objective: To investigate the effect of percutaneous coronary intervention (PCI) on myocardial perfusion in patients with acute myocardial infarction (AMI) after thrombolysis. Methods: A retrospective analysis of 94 cases of the first AMI patients, the onset time were within 12 h. Thirty-six patients received thrombolytic therapy combined with PCI and 58 received PCI. The myocardial perfusion and grading were performed after PCI, and their effects on myocardial perfusion were evaluated. Results: There was no significant difference between the two groups in terms of spontaneous onset and PCI. The first coronary angiography showed that TIMI grade 3 blood flow in infarct-related arteries of thrombolysis plus PCI group increased significantly compared with direct PCI group. Thrombolysis combined with PCI group The success rate of treatment was high, and postoperative TIMI grade 3 blood flow, myocardial perfusion of TMP after PCI more than 2 were significantly more than the direct PCI group; bleeding complication rate was no significant difference between the two groups. Conclusions: Thrombolytic therapy combined with PCI is safe and effective, and the early recanalization rate is high. Myocardial microcirculation perfusion is good and myocardial infarction area is small. It is more conducive to the protection of ventricular function and does not increase bleeding complications.