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目的:观察静脉溶栓后经桡动脉行延迟冠状动脉介入(PCI)治疗急性ST段抬高型心肌梗死(STEMI)的疗效。方法:急性STEMI 80例,根据静脉溶栓后的治疗情况分为观察组38例和对照组42例。入组病例急性期均给予尿激酶或重组组织纤溶酶原激活药静脉溶栓治疗,观察组溶栓后7~10天经桡动脉行延迟PCI治疗,对照组继续内科药物治疗。比较两组住院时间及术后左心室射血分数(LVEF)改善情况,出院后随访主要不良心血管事件(MACE)发生情况。结果:(1)观察组住院时间(13.6±7.6)天,显著短于对照组的(19.5±7.2)天(P<0.05);出院前进行心脏超声检查,观察组LVEF(62.23±4.87)%,显著高于对照组的(50.69±5.27)%(P<0.05)。(2)平均随访(14.5±3.2)个月,观察组MACE发生率13.2%,非常显著低于对照组的42.9%(P<0.01)。结论:急性STEMI患者静脉溶栓后经桡动脉延迟PCI治疗可改善患者左心室功能,降低MACE发生率。
Objective: To observe the curative effect of intravenous thrombolysis on the treatment of acute ST-segment elevation myocardial infarction (STEMI) via radial artery undergoing delayed coronary intervention (PCI). Methods: 80 cases of acute STEMI were divided into observation group (38 cases) and control group (42 cases) according to the treatment of intravenous thrombolysis. The patients in the acute phase were given intravenous thrombolytic therapy with urokinase or recombinant tissue plasminogen activator. The patients in the observation group were treated with delayed PCI through the radial artery 7 to 10 days after thrombolysis in the observation group, and the medical treatment was continued in the control group. The improvement of hospital stay and postoperative left ventricular ejection fraction (LVEF) was compared. The incidence of major adverse cardiovascular events (MACE) was followed up after discharge. Results: (1) The length of stay in the observation group (13.6 ± 7.6) days was significantly shorter than that in the control group (19.5 ± 7.2) days (P <0.05) , Which was significantly higher than that in the control group (50.69 ± 5.27)% (P <0.05). (2) The average follow-up time was (14.5 ± 3.2) months. The incidence of MACE in the observation group was 13.2%, which was significantly lower than that in the control group (42.9%, P <0.01). Conclusion: The delayed intravenous thrombolysis after intravenous thrombolysis in patients with acute STEMI can improve left ventricular function and reduce the incidence of MACE.