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为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗
To investigate the safety and clinical efficacy of direct percutaneous transluminal coronary angioplasty in acute myocardial infarction, 62 patients with acute myocardial infarction who did not receive intravenous or intra-coronary thrombolysis were enrolled in the study. The patients underwent direct coronary angiography Intracavitary coronary angioplasty; another selection of 59 patients with acute myocardial infarction, thrombolytic therapy, thrombolytic therapy is no longer accepted after interventional therapy and surgical coronary bypass, and then compare the direct percutaneous transluminal coronary angioplasty and Thrombolytic therapy efficacy, safety and prognosis. The results showed that 60 cases of direct percutaneous transluminal coronary angioplasty was successfully reperfusion, the success rate was 96.7%, of which 4 patients with cardiogenic shock were reperfusion success, blood pressure rise, acute upper gastrointestinal Bleeding in one case, the mortality rate was 0; thrombolytic therapy group 38 cases of reperfusion success, the success rate was 64.4%, 5 died during hospitalization, 2 died within 6 months after discharge, acute upper gastrointestinal bleeding in 1 case, 1 case of hematuria, 5 cases of cardiogenic shock after thrombolytic therapy, the mortality rate was 11.9%. The success rate of direct percutaneous transluminal coronary angioplasty was significantly higher than thrombolytic therapy, the incidence of death and major cardiac events was significantly lower than that of thrombolytic therapy (P <0.01). The results suggest that direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction is safe and effective, the success rate of reperfusion is significantly higher than thrombolytic therapy, the curative effect and prognosis is superior to thrombolysis