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目的探讨联合应用栓体舒(rt-PA)和急诊介入治疗急性 ST 段抬高心肌梗死(AMI)的有效性和安全性方法收集2002年11月至2005年9月葫芦岛市中心医院心内科32例急性 ST 段抬高心肌梗死患者,将其随机分为溶栓+经皮冠状动脉介入治疗(PCI)组14例和直接急诊经皮冠状动脉介入治疗(PCI)组18例,对两组患者介入治疗前心肌梗死相关动脉(IRA)通畅率、介入治疗成功率、出血并发症发生率、手术操作时间、住院期间急性缺血事件的发生率及出院前左室功能(LVEF)进行比较。结果介入治疗前溶栓+PCI 组 IRA 通畅率(71%)显著高于直接 PCI 组(22%)。手术时间短于直接 PCI 组,分别为(1.5±0.3)h和(3.1±1.5)h。两组介入成功率均为100%,其中 TIMI3级血流者分别为93%和89%。住院期间两组均无严重出血及急性缺血事件发生,出院前经超声心动图测得 LVEF 分别为溶栓+PCI 组(65.2±2.7)%,直接PCI 组(55.2±2.1)%。结论 rt-PA 静脉溶栓联合急诊介入治疗 AMI 早期再通率高,手术操作时间短,更有利于保护左室功能,不增加出血并发症。
Objective To investigate the efficacy and safety of combined administration of Xueshu Shu (rt-PA) and emergency interventional treatment of acute ST-segment elevation myocardial infarction (AMI) in our hospital from November 2002 to September 2005. Huludao Central Hospital Cardiology Thirty-two patients with acute ST-segment elevation myocardial infarction were randomly divided into thrombolytic and percutaneous coronary intervention (PCI) group (n = 14) and direct emergency percutaneous coronary intervention (PCI) The rate of patency, the success rate of interventional therapy, the incidence of bleeding complications, the duration of operation, the incidence of acute ischemic events during hospitalization and left ventricular ejection fraction (LVEF) before PCI were compared. Results The IRA patency rate (71%) before PCI was significantly higher in the thrombolysis + PCI group than in the direct PCI group (22%). The operative time was shorter than that of the direct PCI group (1.5 ± 0.3) h and (3.1 ± 1.5) h, respectively. The successful rates of intervention in both groups were 100%, of which TIMI grade 3 were 93% and 89%, respectively. During hospitalization, there were no severe hemorrhage and acute ischemic events in both groups. LVEF measured by echocardiography before discharge from the hospital was 65.2 ± 2.7% in the thrombolysis group and 55.2 ± 2.1% in the direct PCI group, respectively. Conclusion rt-PA intravenous thrombolysis combined with emergency intervention in early AMI high recanalization rate, short operative time, more conducive to the protection of left ventricular function, does not increase bleeding complications.