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目的:比较直接经皮冠脉介入治疗(直接PCI)与静脉溶栓治疗急性ST段抬高型心肌梗死患者的疗效。方法:回顾分析我院收治的急性心梗并行再灌注治疗243例患者的临床资料,根据再灌注方法分为直接PCI组(A组,n=198)和静脉rt-PA溶栓组(B组,n=45),比较两组病人住院期间的主要临床事件结果。结果:在平均住院日、出院时血浆BNP改善率及左室射血分数(LVEF)上,直接PCI组均优于静脉溶栓组(P<0.05);心肌再梗以及心源性死亡的发生率在直接PCI组明显降低(P<0.05)。但年龄小于65岁,或发病在3h内的患者,两种干预方法的近期死亡率无统计学差异。静脉溶栓组患者就诊至开始干预治疗时间明显短于直接PCI组(P<0.01),且静脉溶栓组未作择期PCI的患者其治疗费用明显降低(P<0.01)。结论:直接PCI在治疗急性ST段抬高型心梗患者的总体效果优于静脉溶栓疗。但静脉溶栓起效快、费用低;对发病在3 h内的患者,两种再灌注方法近期疗效相近。
Objective: To compare the efficacy of direct percutaneous coronary intervention (PCI) with intravenous thrombolysis in patients with acute ST-segment elevation myocardial infarction. Methods: The clinical data of 243 patients with acute myocardial infarction (MI) treated in our hospital were retrospectively analyzed. According to the method of reperfusion, the patients were divided into direct PCI group (group A, n = 198) and intravenous rt-PA thrombolysis group , n = 45). The results of major clinical events during hospitalization were compared between the two groups. Results: In the average length of hospital stay, the rate of improvement of plasma BNP and left ventricular ejection fraction (LVEF) at discharge, the direct PCI group was superior to the intravenous thrombolysis group (P <0.05); myocardial infarction and cardiogenic death The rate was significantly lower in the direct PCI group (P <0.05). However, in patients younger than 65 years or within 3 hours of onset, there was no significant difference in the near-term mortality between the two interventions. Patients in the intravenous thrombolytic group were significantly shorter than those in the direct PCI group (P <0.01), and the cost of treatment was significantly lower in patients who received no intravenous thrombolytic therapy (P <0.01). Conclusions: The overall effect of direct PCI in the treatment of acute ST-segment MI is superior to intravenous thrombolysis. However, intravenous thrombolytic rapid onset, low cost; for patients within 3 h of onset, the two reperfusion methods similar to the recent efficacy.