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目的 探讨急性心肌梗死 (AMI)静脉溶栓与时间限定性补救经皮冠状动脉腔内介入(PCI)顺序疗法的合理性、安全性及有效性。方法 1999年 1月至 2 0 0 2年 10月入院的 10 2例AMI患者中 ,4 4例接受直接PCI治疗 ,5 8例首先接受尿激酶静脉溶栓 ,限定自溶栓开始 90min内仍未再通者立即行补救性PCI,溶栓再通者则行择期冠状动脉造影 ,选择治疗方案。对以上两种方法的再通率、并发症、第 4周左室射血分数 (LVEF)等临床资料进行分析 ,对静脉溶栓与时间限定性补救PCI顺序疗法的可行性、安全性、有效性进行评价。结果 直接PCI组再通率 95 4 5 % (4 2 / 4 4 ) ,静脉溶栓 +拟行时间限定性补救PCI组 90min内溶栓再通率 32 76 % (19/ 5 8) ,补救PCI再通率 97 4 3% (38/ 39) ;直接PCI组 2例于支架置入后出现无或缓再流现象 ,静脉溶栓未通 +时间限定性补救PCI者 1例出现缓再流现象 ,静脉溶栓再通者至择期介入诊疗前无梗死相关血管 (IRA)再闭塞 ;直接PCI组消化道出血 2例 ,溶栓未通 +补救PCI组 1例出现血尿 ,无其它出血及穿刺部位血肿发生 ;第 4周超声心动图检查结果 :直接PCI组平均LVEF为 5 9 5 % ,静脉溶栓未通 +补救PCI组为 5 8 8% ,溶栓再通 +延迟PCI组为 6 0 4 % (P >0 0 5 ) ,6h以内再通者LVEF为 6 2 7% ,6h以?
Objective To investigate the rationality, safety and efficacy of intravenous thrombolysis in acute myocardial infarction (AMI) and time-limited remedial percutaneous coronary intervention (PCI). METHODS: Of the 102 AMI patients admitted to our hospital from January 1999 to October 2002, 44 received direct PCI and 58 received intravenous urokinase for the first time Recanalization immediately after the rescue PCI, thrombolytic recanalization is scheduled elective coronary angiography, select the treatment options. The clinical data of recanalization rate, complications, left ventricular ejection fraction (LVEF) at the 4th week of the above two methods were analyzed and the feasibility, safety and effectiveness of intravenous thrombolysis and time-limited salvage PCI sequential therapy were analyzed Sexual evaluation. Results The rate of recanalization was 95.45% (4 2/4 4) in the direct PCI group. The rate of thrombolysis recanalization was 32 76% (19/58) within 90 min in the intravenous thrombolysis + And the recanalization rate was 97.43% (38/39). There was no or mild reflow phenomenon in 2 cases of direct PCI group after PCI , Intravenous thrombolytic recanalization to elective intervention before treatment without infarction-related blood vessels (IRA) reocclusion; direct PCI group of gastrointestinal bleeding in 2 cases, thrombolysis failed + rescue PCI group, 1 case of hematuria, no other bleeding and puncture site The results of echocardiography in the fourth week showed that the average LVEF in the direct PCI group was 59.5%, the rate of intravenous thrombolysis in the reoperation PCI group was 58.8%, and that in the thrombolytic regimen + delayed PCI group was 60.4% % (P> 0.05), LVEF was 6 2 7% within 6h, 6h?