急性心肌梗死静脉溶栓后补救介入治疗的临床疗效

目的探讨急性心肌梗死静脉溶栓后90min未通补救经皮冠状动脉内介入疗法的安全性和有效性。方法102例AMI患者分别行直接PCI术(38例)和64例接受rtPA(爱通力)或尿激酶静脉溶栓,限定自溶栓开始后90min内仍未再通者立即行补救性PCI,溶栓再通者则行择期冠状动脉造影,选择治疗方案。对以上两种方法的再通率、并发症、一个月后的左室射血分数等临床资料进行分析,对静脉溶栓和90min内补救PCI顺序疗法的安全性,有效性进行评价。结果直接PCI组再通率为94.7%(36/38),静脉溶栓 补救PCI组90min溶栓再通率为31.3%(20/64),补救PCI再通率为95.5%(42/44);直接PCI组2例于支架置入后出现无再流现象,补救PCI组1例出现无复流,静脉溶栓再通到择期介入治疗前无梗死相关血管(IRA)再闭塞;直接PCI组消化道出血1例,补救PCI组2例出现血尿。延迟PCI组1例出现脑出血后死亡。1个月后超声心动图检查结果:直接PCI组平均为58.2%,静脉溶栓未通 补救PCI组57.4%,溶栓再通 延迟PCI组为61.3%(P>0.05)。12h以内再通者LVEF为63.2%,12h以后再通者LVEF为51.3%(P<0.05).结论静脉溶栓失败后补救性PCI是合理有效安全的方法。

Rescue percutaneous coronary intervention for failed thrombolisisin in acute myocardial infarction

Objective To evaluate the safety and efficiency of the rescue angioplasty following thrombolttic therapy in acute myocardial infarction(AMI). Methods Among the patients within 12 hours from the onset of symptoms of AMI,58cases (subgroup A)underwent primary coronary angioplasty and 64 cases(subgroup B) underwent intravenous thrombolitic therapy. According to clinical early reperfusion indication within 90 minutes following thrombolic therapy,group B was divided two subgroups,the patients with early reperfution (subgroup C)underwent delayed interventional examination 7-10 days after AMI and that with non-reperfution (subgroup D)underwent rescue angioplasty the reperfution rates and complications in different groups were analyzed and compared.Cardiac function(left ventricular ejection fraction,LVEF)was evaluated by echocardiograph 1month after AMI. Results The results showed that the rate of reperfusion,in group A is 94.7%(36/38),that of subgroup D was 95.5%(42/44)within 90 minutes following thrombolic therapy. There were no serious complications that occurred in subgroup C and D, The LVEFs in group A,subgroupC and D were not significantly different,but there was a significant difference between referfusion within 12 hours and beyond after AMI (63.2% vs 51.3%,P<0.05). Conclusion The resue angioplasty following failed thrombolic therapy is safe and efficient.