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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年04期

页码:

307-310

栏目:

临床医学

出版日期:

2016-07-19

文章信息/Info

Title:

Comparison of different reperfusion methods?in? patients with STEMI

文章编号:

1006-8147（2016）04-0307-04

作者:

?张伟杰¹; 4; 丛洪良²; 李春洁²; 李婷婷²; 张文艳³; 贾秀丽⁴; 吴 伟⁴; 刘彩霞⁴; 张梦阳⁴

(1.天津医科大学研究生院 天津 300070;2.天津市胸科医院心内科, 天津 300222;3.天津市西青医院心内科, 天津 300380;4.天津市南开区中医医院心内科,天津 300101)

Author(s):

ZHANG Wei-jie¹.⁴ ;  CONG Hong-liang²; LI Chun-jie² ; LI Ting-ting² ; ZHANG Wen-yan³;  JIA Xiu-li⁴ ; WU Wei⁴ ; LIU Cai-xia⁴; ZHANG Meng-yang⁴

(1.Graduate School , Tianjin Medical University, Tianjin 300070,China; 2. Department of Cardiology ,Tianjin Chest Hospital, Tianjin 300222,China;3. Department of Cardiology ,Tianjin Xiqing Hospital,Tianjin 300380, China;4. Department of Cardiology ,Nankai Hospital of Traditional Chinese Medicine, Tianjin 300101,China)

关键词:

经皮冠状动脉介入治疗' target="_blank" rel="external">">经皮冠状动脉介入治疗;  静脉溶栓; 急性ST段抬高型心肌梗死

Keywords:

percutaneous coronary intervention' target="_blank" rel="external">">percutaneous coronary intervention;  intravenous thrombolytic therapy;  acute S T elevated myocardial infarction

分类号:

R542.2+2

DOI:

-

文献标志码:

A

摘要:

目的: 比较不同急性ST段型抬高心肌梗死(STEMI）患者静脉溶栓治疗、溶栓成功后延迟经皮冠状动脉介入治疗（PCI）治疗、直接PCI治疗的临床疗效及近期预后。 方法:入选符合入组标准的218例STEMI患者。根据患者就诊时间及治疗的实际情况分组：A组即PPCI治疗（90例）；B组即只进行静脉溶栓治疗（78例），将发病3h内溶栓的患者分为B1组（30例)，超过3 h分为B2组（48例)；C组即溶栓成功后延迟PCI治疗组（50例）。 支架及用药方法:A组、C组患者罪犯血管是PCI治疗的唯一目标，不限制支架的应用与选择。3组患者治疗方案均遵循STEMI治疗指南。随访指标: 218例患者均在术后30 d接受门诊随访。比较住院和随访期间的心脏事件（MACE事件）、复合终点事件和心脏彩超[左室射血分数（LVEF）、左室舒张末径（LVEDD）]变化。结果: 218例患者均进入结果分析。（1）各组患者间基线资料和临床资料比较差异均无统计学意义，各组间具有可比性；（2）随访期间MACE事件及复合终点事件发生率：A组低于B2组、C组,差异有统计学意义（P <0.05）。（3）随访期间A组LVEF高于B2组、C组，C组LVEF高于B2组；A组LVEDD低于B2组、C组，C组LVEDD低于B2组，比较差异有统计学意义（ P <0.05）。结论: 直接PCI是STEMI患者最有效的再灌注治疗方法；发病3 h内的患者，溶栓治疗的即刻效果及30 d预后不劣于直接PCI。溶栓治疗并不是STEMI患者的治疗终点。

Abstract:

Objective: To compare the clinical effectiveness and prognosis of different acute ST elevated myocardial infarction (STEMI) patients by intravenous thrombolytic therapy, PCI treatment after thrombolytic and direct PCI treatment. Methods: Two hundred and eighteen STEMI patients were selected. Basing on the treatment time and condition, the patients were divided into three groups. Group A was treated with PPCI (90 cases), group B with intravenous thrombolytic therapy (78 cases), and were further divided into B1 group(30 cases) where patients were thrombolytic within 3 h and B2 group(48 cases) with more than 3 h. Group C (50 cases) were treated with delayed PCI after thrombolytic. Stent and treatment methods: Arteries of patients in Group A and C were the only goal for PCI treatment, without limiting the application and selection of stent. The treatment scheme of 3 groups had all followed STEMI guidelines. Follow-up indicators included MACE, composite end point event, LVEF and LVEDD. All of postoperative patients accepted the outpatient follow-up within 30 days. Differences between hospitalization and follow-up period in MACE, composite end point event, LVEF and LVEDD indicators were compared. Results: The result analysis included all patients. (1)There were no statistical differences between the groups in terms of the patients‘ baseline data and clinical data. (2)The incidence of MACE and composite end point event during the follow-up period: group A was lower than group B2 and group C. The difference was statistically significant（P <0.05）.(3)During the follow–up period, the LVEF indicator for group A was higher than group B2 and group C, the LVEF indicator for group C was higher than group B2, the LVEDD indicator for group A was lower than group B2 and group C, and the LVEDD indicator for group C was lower than group B2. The difference was statistically significant (P <0.05).Conclusion: Direct PCI may be the most effective method of reperfusion therapy for patients with STEMI. As for the patients within 3 hours, thrombolytic therapy method is not inferior to the direct PCI in terms of immediate effect and prognosis of 30 days. As for the patients with STEMI, thrombolytic therapy may not be the final answer.

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备注/Memo

备注/Memo:

作者简介 张伟杰（1982-），女，主治医师，硕士在读，研究方向：心血管内科；
通信作者：丛洪良，E-mail: hongliangcong@163.com

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更新日期/Last Update: 2016-07-13