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目的:探讨急性心肌梗死(AMI)后直接或择期经皮冠状动脉腔内成形术(PTCA)及支架植入对患者早期康复的影响。方法:108例初次AMI患者分为直接PTCA组(n=65例)和择期PTCA组(n=43例)。直接PTCA组于发病后6±4.23h对梗死相关动脉行PTCA及支架术,择期PTCA组于发病后10±3.41天行PTCA及支架术。患者出院后随访6个月,主要终点为死亡和再梗死,次要终点为临床心功能分级、心绞痛分级、生活自理能力和精神状态。结果:失随访5例(直接PTCA组和择期PTCA组分别为3例和2例),随访率为95.4%。直接PTCA组与择期PTCA组随访6个月内死亡、再梗死、介入治疗及精神状态差异无显著性(P>0.05);两组心功能分级、心绞痛分级和生活自理能力比较差异有显著性(P<0.05)。结论:直接PTCA及支架术治疗AMI较择期PTCA及支架术能改善患者心功能、减少心绞痛发作和提高患者自理生活能力。
Objective: To investigate the effect of direct or selective percutaneous transluminal coronary angioplasty (PTCA) and stent implantation on the early rehabilitation of patients after acute myocardial infarction (AMI). Methods: 108 patients with primary AMI were divided into direct PTCA group (n = 65) and elective PTCA group (n = 43). In PTCA group, PTCA and stenting were performed on the infarct-related artery 6 ± 4.23h after the onset of PTCA. PTCA and stenting were performed 10 ± 3.41 days after the onset of PTCA. The patients were followed up for 6 months after discharge. The primary end points were death and reinfarction. The secondary endpoints were clinical cardiac function classification, angina pectoris classification, life self-care ability and mental status. Results: There were 5 cases missing follow-up (3 cases and 2 cases in direct PTCA group and elective PTCA group respectively). The follow-up rate was 95.4%. There was no significant difference between the direct PTCA group and the elective PTCA group within 6 months after follow-up (P> 0.05). There was significant difference between the two groups in cardiac function classification, angina grade and self-care ability P <0.05). Conclusions: Direct PTCA and stenting can improve cardiac function, reduce angina pectoris and improve self-care ability of patients with AMI over elective PTCA and stenting.