叶国红,关贤颂,戴海鹰,蒋路平

• 1:长沙市中心医院心内科

摘要(Abstract)：

目的比较急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)溶栓后TIMI血流Ⅲ级患者早期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和择期PCI的临床疗效。方法入选153例在外院行溶栓治疗成功后转入长沙市中心医院行冠状动脉造影(coronary angiography,CAG)示梗死相关血管TIMI血流Ⅲ级的STEMI患者,根据处理措施分为早期PCI组(即溶栓后24 h内行PCI者,74例)和择期PCI组(起病7~9 d后行择期PCI者,79例)。比较两组患者30 d死亡率、再发心肌梗死、再发心肌缺血症状、新发心力衰竭或心力衰竭加重、心源性休克,6个月和12个月再发心肌梗死、死亡,以及住院期间出血并发症的发生情况。结果早期PCI组行PCI的患者共70例(70/74,94.6%),择期PCI组行PCI的患者共67例(67/79,84.8%),两组患者PCI所占比例比较,差异有统计学意义(P=0.048)。早期PCI组血栓抽吸[17.1%(12/70)比6.0%(4/67),P=0.024]、PCI术中及术后使用替罗非班[81.4%(57/70)比64.2%(43/67),P=0.003]患者所占比例均显著高于择期PCI组,差异均有统计学意义;术中慢血流无复流[8.6%(6/70)比1.5%(1/67)]患者比例在早期PCI组中亦有升高趋势,但差异无统计学意义(P=0.117)。早期PCI组和择期PCI组患者终点事件发生率在随访30 d[12.2%(9/74)比13.9%(11/79),P=0.747]、6个月[8.1%(6/74)比7.7%(6/78),P=0.924]、12个月[10.8%(8/74)比11.5%(9/78),P=0.887]时分别比较,差异均无统计学意义。早期PCI组住院期间出血事件较择期PCI组[17.6%(13/74)比12.7%(10/79)]升高,但差异无统计学意义(P=0.396)。结论 STEMI溶栓成功后CAG示梗死相关血管TIMI血流Ⅲ级的患者,早期PCI不能降低30 d死亡、再发心肌梗死及心力衰竭发生率,对长期死亡率及再发心肌梗死发生率亦无明显改善,且可能增加手术并发症。

关键词(KeyWords)： 急性ST段抬高心肌梗死;溶栓;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 叶国红,关贤颂,戴海鹰,蒋路平

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