摘要
目的:评价小剂量溶栓剂重组组织型纤溶酶原激活剂(50mgrt-PA)联合经皮冠状动脉介入(易化PCI)治疗ST段抬高急性心肌梗死(STEMI)的疗效和安全性。方法:215例STEMI患者,150例行直接PCI(直接PCI组),65例rt-PA50mg滴注30min后行PCI(易化PCI组),两组患者中心肌梗死溶栓试验(TIMI)0￣2级和3级但残余狭窄≥70%者(直接PCI组132例,易化PCI组52例)置入支架。比较两组PCI前后梗死相关动脉(IRA)开通率、支架置入率、ST段回落率、出院前左室射血分数、住院期间出血事件和主要不良心脏事件(MACE)。结果:易化PCI组首次冠状动脉造影IRA开通率和TIMI3级血流率显著高于直接PCI组(49.2%vs20.0%,P=0.00;27.7%vs14.0%,P=0.02),术后TIMI3级血流率、ST段回落率和出院前左室射血分数亦显著高于直接PCI组[96.9%vs88.0%,P=0.04;92.3%vs78.7%,P=0.01;(64.5±7.9)%vs(51.5±15.6)%,P<0.05],而两组支架置入率、住院期间出血事件和MACE无显著差异,且均未发生脑出血。结论:在STEMI治疗中,易化PCI可使缺血心肌获得尽早再灌注,为进一步血运重建赢得时间,提高了STEMI患者术后TIMI3级血流率、改善了心肌组织水平再灌注和心功能,且未明显增加住院期间出血事件和MACE,值得推广应用。
Objective: To evaluate the efficacy and safety of facilitated PCI (low-dose rt-PA combined with immediate planned rescue percutaneous coronary intervention) in ST-segment elevation acute myocardial infarction (STEMI). Methods: Two hundred and fifteen patients with STEMI were divided into direct PCI group (n=150) and facilitated PCI group (n=65). The patients in direct PCI group were under angiography without thrombolysis, while the patients in facilitated PCI group were under an intravenous drip of 50 mg rt-PA during 30 minutes before PCI. The patients with TIMI grade 0~2 or TIMI grade 3 but residual stenosis ≥70% (132 patients in direct PCI group, 52 patients in facilitated PCI group) were implanted with stents. The rates of recanalization before and after PCI, of the usage of stents,of ST-segment resolution, and the left ventricular ejection fraction (LVEF) and major hemorrhage and major adverse cardiac events (MACE) in hospital were compared in two groups. Results: Compared with direct PCI group, the rates of recanalization and TIMI grade 3 before angioplasty were significantly higher in facilitated PCI group(49.2% vs 20.0%, P=0.00; 27.7% vs 14.0%, P=0.02); the rate of TIMI grade 3, ST resolution after angioplasty and LVEF in facilitated PCI group were significantly higher [96.9% vs 88.0%, P=0.04; 92.3% vs 78.7%, P=0.01; (64.5±7.9)% vs (51.5±15.6)%; P<0.05]. There were not significantly different for usage of stents, major hemorrhage and MACE in two groups. There was no intracerebral bleeding in two groups. Conclusion: Facilitated PCI, which can reduce the time of reperfusion-beginning and improve the rate of TIMI grade 3 and myocardial reperfusion and left ventricular function without increasing MACE and major hemorrhage, is effective and safe for the patients with STEMI without thrombolysis contraindication.
出处
《山东大学学报（医学版）》
CAS
北大核心
2005年第6期481-483,491,共4页
Journal of Shandong University:Health Sciences
基金
山东省卫生厅青年科学基金资助项目(1999CA2CJB1)
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
重组组织型纤溶酶原激活剂
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Recombinationtissue tissue plasminogen activator
