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目的:探讨溶栓失败后即刻补救性介入治疗术(PCI)——经皮腔内冠状动脉成形术(PTCA)或支架置入术(STENT)治疗急性心肌梗死(AMI)的安全性及近期疗效。方法:将59例AMI患者分为直接PCI组(A组)、补救性PCI组(B组)2组。A组31例,直接行PCI;B组28例,静脉溶栓后120min时,依冠状动脉开通临床标准进行判定,若溶栓失败立即行PCI。2组患者均于PCI前及PCI后即刻行冠状动脉造影观察再通率。治疗后3周用超声心动图测量并计算左室射血分数、住院期间再发心肌缺血事件发生率、病死率、出血并发症及住院天数。结果:2组患者梗死相关血管的再通率、住院期间死亡率、支架置入成功率、住院期间再梗死率、平均住院天数、出血并发症及心功能均差异无统计学意义。结论:补救性PCI成功率高,具有较好的临床效果,并未增加出血并发症,可以在临床推广应用。
Objective: To investigate the safety and short-term efficacy of immediate interventional PCI (PCI) - percutaneous transluminal coronary angioplasty (PTCA) or stenting (STENT) for acute myocardial infarction (AMI) after failure of thrombolysis . Methods: Fifty-nine AMI patients were divided into two groups: direct PCI group (A group) and rescue PCI group (B group). A group of 31 cases, direct PCI; B group 28 cases, 120min after intravenous thrombolysis, according to the clinical standard of coronary artery to judge, if thrombolytic failure immediately PCI. Two groups of patients underwent coronary angiography before PCI and immediately after PCI to observe the recanalization rate. Three weeks after treatment, left ventricular ejection fraction (LVEF) was measured and calculated by echocardiography. The incidence of myocardial ischemic events, mortality, bleeding complications and length of hospital stay were also reported during hospitalization. Results: There was no significant difference in recanalization rate, in-hospital mortality rate, success rate of stent implantation, reinfarction rate during hospitalization, average length of stay, bleeding complications and cardiac function in the two groups. Conclusion: The success rate of remedial PCI is high, which has good clinical effect, does not increase the bleeding complications and can be popularized and applied in clinic.