【摘要】：目的:觀察靜脈溶栓聯(lián)合急診經(jīng)皮冠狀動(dòng)脈介入治療(PCI)在ST段心肌梗死(STEMI)再灌注治療中的療效性及安全性,為改善我國(guó)STEMI再灌注治療現(xiàn)狀提供一種新的方案。方法:納入就診于解放軍第264醫(yī)院的發(fā)病12小時(shí)內(nèi)的50例STEMI患者,根據(jù)患者是否接受靜脈溶栓治療分為溶栓聯(lián)合急診PCI組(20例)和直接PCI(pPCI)組(30例)。觀察指標(biāo)中主要終點(diǎn)事件為PCI術(shù)前冠狀動(dòng)脈梗死相關(guān)血管的TIMI血流分級(jí)、PCI術(shù)后校正的TIMI血流計(jì)幀數(shù)(CTFC)、TIMI心肌灌注分級(jí)及住院期間主要心臟不良事件(MACE)發(fā)生率;次要終點(diǎn)事件為住院期間出血并發(fā)癥及隨訪1年內(nèi)的MACE發(fā)生率。結(jié)果:兩組患者的臨床基線指標(biāo)無明顯差異。溶栓聯(lián)合急診PCI組在就診至開始實(shí)施再灌注治療的中位時(shí)間明顯短于pPCI組(32.0min vs.72.5min,p0.05)。冠狀動(dòng)脈造影后溶栓聯(lián)合急診PCI組的罪犯血管TIMI血流分級(jí)≥2級(jí)的比列明顯高于PPCI組(60.0%vs.16.7%,p0.05),溶栓聯(lián)合急診PCI組的高負(fù)荷血栓比列明顯低于pPCI組(20.0%vs.50.0%,p0.05);PCI術(shù)后,2組的TIMI血流分級(jí)達(dá)到3級(jí)的比例無明顯差異,但溶栓聯(lián)合急診PCI組TMPG達(dá)到3級(jí)的比例明顯的高于pPCI組(85.0%vs.53.3%,p0.05),同時(shí)術(shù)后CTFC幀數(shù)也低于pPCI組[(28.5±3.0)vs.(31.5±3.8),p0.05)]。兩組住院期間及1年隨訪期內(nèi)MACE發(fā)生率無明顯差異;兩組住院期間的出血并發(fā)癥發(fā)生率無明顯差異。結(jié)論:基于我國(guó)當(dāng)前STEMI再灌注治療現(xiàn)狀,靜脈溶栓聯(lián)合急診PCI在救治STEMI患者時(shí)能夠明顯縮短實(shí)施再灌注治療時(shí)間,同時(shí)其療效性不劣于直接PCI,并且也未增加出血風(fēng)險(xiǎn),或許能為改善我國(guó)STEMI再灌注治療提供一種有現(xiàn)實(shí)意義的參考策略。
[Abstract]:Objective: to observe the efficacy and safety of intravenous thrombolytic therapy combined with emergency percutaneous coronary intervention (PCI) in the treatment of St segment myocardial infarction (St) myocardial infarction with (STEMI) reperfusion, and to provide a new scheme for improving the current status of STEMI reperfusion therapy in China. Methods: 50 patients with STEMI within 12 hours of onset were enrolled. According to whether the patients received intravenous thrombolytic therapy, they were divided into two groups: thrombolytic therapy combined with emergency PCI group (n = 20) and direct PCI (pPCI) group (n = 30). The main endpoint events were the TIMI blood flow grade of coronary infarction related vessels before and after PCI, the corrected (CTFC) / TIMI myocardial perfusion grade and the incidence of major adverse cardiac events (MACE) during hospitalization. Secondary endpoint events were bleeding complications during hospitalization and the incidence of MACE during one year follow-up. Results: there was no significant difference in clinical baseline between the two groups. The median time of thrombolytic therapy combined with emergency PCI group was significantly shorter than that of pPCI group (32.0min vs.72.5 min / p0.05). The ratio of TIMI blood flow grade 鈮，

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