摘要
目的比较易化经皮冠状动脉介入(facilitated percutaneous coronary intervention,FPCI)与直接经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗ST段抬高型心肌梗死(ST-segment elevationmyocardial infarction,STEMI)患者的疗效及安全性。方法连续收集158例首次STEMI患者,其中80例患者为基层卫生院给予静脉全量尿激酶溶栓联合经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗即FPCI组,78例患者为由基层卫生院直接转运行经皮冠状动脉介入治疗即PPCI组。观察两组患者梗死相关血管(infarctionrelated artery,IRA)再通情况及主要出血并发症,并分别于PCI术后第30天和第180天行心脏超声心动图检查,评价心功能改善情况,随访6个月,比较两组患者IRA再闭塞、心力衰竭、脑卒中及心源性猝死等的发生情况。结果首次冠状动脉造影显示FPCI组PCI术前心肌梗死试验性溶栓治疗(TIMI)3级血流率明显高于PPCI组(P=0.001),术后TIMI3级血流率差异无统计学意义(P=0.762);住院期间主要出血并发症FPCI组高于PPCI组,但差异无统计学意义(P=0.491);两组患者术后30天、术后180天左心室射血分数比较差异均无统计学意义(P>0.05),分别为(51.3±4.2)%vs(50.7±5.2)%,(52.8±6.7)%vs(54.8±6.3)%。两组患者IRA再闭塞、心力衰竭、脑卒中及心源性猝死发生率比较差异无统计学意义(P>0.05)。结论FPCI是安全有效的,对于基层卫生院首诊的STEMI患者,如果发病时间未超过2小时且转运时间可能超过3小时,可以先行溶栓后转运至三甲医院行PCI治疗。
Objective To observe the clinical effects and safety of facilitated percutaneous coronary intervention （FPCI） and primary percutaneous coronary intervention（FPCI） for patients with ST-segment elevation myocardial infarction（STEMI）. Methods 158 consecutive STEMI patients who had the first myocardial infarction were enrolled in the study. These 158 cases were divided into two groups：FPCl group （ n =80） and PPCI group （ n =78）. The patients in FPCI group first received thrombolytic treatment with full dose urokinase in community hospitals, meanwhile they were tranferred to the catherlab at once and received PCI,while the patients in PPCI group were transferred directly from community hospitals to receive PCI. Before and after PCI thrombolysis in myocardial infarction（TIMI） flow grade,major hemorrhage incidence were observed in hospital. All patients received cardiac ultrasonic examination in 30 days and 180 days from the PCI to get the value of left ventricular ejection fraction（LVEF） to evaluate the cardiac function. Major adverse cardiac events （MACE） were observed during the 6 months＂ follow-up. Results There were similar clinical and coronary characteristics between two groups. Compared with FPCI group,the rate of TIMI grade 3 before angioplasty was significantly higher in FPCI group（ P =0. 001）. The rate of TIMI grade 3 after angioplasty was no significant difference between two groups（ P = 0. 762）. The rate of major hemorrhage incidence in hospital was higher in FPCI,but there was no significant difference between two groups（ P = 0. 491）. There were no difference in LVEF（60 days and 180 days after PCI） （51.3±4.2）% vs （50. 7±5.2）% ,（52.8±6.7）% vs （54.8±6.3）% ,There were no difference in IRA reocclusion, heart failure, stroke or sudden cardiac death between two groups. Conclusion FPCI is safe,efficient and feasible. If the time from symptom onset to admission is less than 2 hours and the duration of transportation for reperfusion would be over 3 hours,the FPCI can be considered.
出处
《临床荟萃》
CAS
2009年第21期1844-1848,共5页
Clinical Focus
