张守文,王彩虹,王洁,潘金,庄萍,邵明凤,张秋林,马波江,李新华

• 1:山东省临沂市人民医院心内科
• 2:山东省临沂市人民医院药剂科
• 3:山东省临沂市人民医院导管室
• 4:河北省泊头市医院内二科

摘要(Abstract)：

目的评价半量瑞替普酶溶栓后行易化经皮冠状动脉介入治疗(PCI)对急性ST段抬高心肌梗死(STEMI)患者的疗效和安全性。方法采用前瞻性、开放性的临床研究方法,观察2011年1月至2013年9月在山东省临沂市人民医院接受易化PCI和直接PCI的STEMI患者,分为易化PCI组(65例)和直接PCI组(70例),比较两组患者梗死相关血管(IRA)再通率、左心室射血分数(LVEF)、主要不良心血管事件(MACE,包括心原性死亡、再发心肌梗死、缺血复发、新发心力衰竭或心力衰竭恶化、出血等)发生率。结果易化PCI组再通率95.4%,直接PCI组再通率94.3%,两组患者冠状动脉再通率,术后30 d、3个月、6个月及12个月的LVEF比较,差异无统计学意义(P>0.05);术后30 d、3个月、6个月、12个月内MACE比较,差异无统计学意义(P>0.05)。结论应用半量瑞替普酶(r-PA)对STEMI患者行易化PCI是有效、安全的;在无直接PCI条件的医院,易化PCI是可行的。

关键词(KeyWords)： 心肌梗死;瑞替普酶;溶栓治疗;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 山东省临沂市2012年科学技术计划(201213033)

作者(Author): 张守文,王彩虹,王洁,潘金,庄萍,邵明凤,张秋林,马波江,李新华

参考文献(References)：

• [1]O'Gara PT,Kushner FG,Ascheim DD,et al,2013 ACCF/AHA guidelines for the management of ST-elevation myocardial infarction:a report of the American college of cadiology foundation/American heart association task force on practice guidelines.J Am Coll Cardiol,2013,61:78-140.
• [2]Steg PG,James SK,Atar D,et al,ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J,2012,33:2569-2619.
• [3]Shen LH,Wan F,Shen L,et al.Pharmacoinvasive therapy for ST elevation myocardial infarction in China:a pilot study.J Thromb Thrombolysis,2012,33:101-108.
• [4]万方,张拓,沈玲红,等.急性ST段抬高心肌梗死溶栓后早期介入治疗与直接介入治疗的对比研究.中国介入心脏病学杂志,2013,21:3-7.
• [5]瑞替普酶(派通欣)Ⅱ期临床试验协作组.注射用瑞替普酶(派通欣)治疗急性心肌梗死有效性及安全性临床研究.中国心血管病研究杂志,2004,2:171-174.
• [6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38:675-690.
• [7]陈明,郑博.2013美国ST段抬高心肌梗死指南解读.中国医学前沿杂志(电子版),2013,2:47-50.
• [8]刘书山,胡大一,杨进刚,等.节假日对ST段抬高心肌梗死院内再灌注延迟的影响.中国介入心脏病学杂志,2008,16:91-94.
• [9]Zhang SY,Hu DY,Sun YH,et al.Current management of patients with ST elevation myocardial infarction in metropolitan Beijing,China.Clin Invest Med,2008,31:189-197.
• [10]Steg PG,Bonnefoy E,Charbaud S,et al.Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty:data from the CAPTIM randomized clinical trial.Circulation,2003,108:2851-2856.
• [11]Carver A,Rafelt S,Gershlick AH,et al.Longer-term follow-up of patients recruited to the REACT(Rescue Angioplasty Versus Conservative Treatment or Repeat Thrombolysis)trial.J Am Coll Cardiol,2009,54:118-126.
• [12]ASSENT-4 PCI Investigators.Primary versus tenecteplasefacilitated percutaneous coronary intervention in patients with STsegment elevation acute myocardial infarction(ASSENT-4 PCI):randomized trial.Lancet,2006,367:569-578.
• [13]Collet JP,Montalescot G,Le May M,et al.Percutaneous coronary intervention after fibrinolysis:amultiple meta-analyses approach according to the type of strategy.J Am Coll Cardiol,2006,48:1326-1335.
• [14]Borgia F,Goodman SG,Halvorsen S,et al.Early routine percutanious coronary intervention after fibrinolysis vs.standard therapy in ST-segment elevation myocardial infarction:a metaanalysis.Eur Heart J,2010,31:2156-2169.
• [15]Cantor WJ,Fitchett D,Borgundyaag B,et al.Routine early angioplasty after fibrinolysis for acute myocardial infarction.N Engl J Med,2009,360:2705-2718.
• [16]Di Mario C,Dudek D,Piscione F,et al.Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction(CARESS-in-AMI):an open,prospective,randomised,multicentre trial.Lancet,2008,371:559-568.