慢性阻塞性肺病并发急性心肌梗死的溶栓疗效探讨

目的：通过对慢性阻塞性肺病（COPD）并发急性心肌梗死（AMI）后溶栓疗效观察，评价COPD并发AMI患者对溶栓的耐受性及预后影响。方法：收集同期住院接受溶栓治疗的179例AMI的临床资料，将其中合并COPD的56例与非COPD的123例行对比分析，观察两组溶栓后冠脉再通率，住院期间并发症的发生率及住院病死率。结果：溶栓后冠脉再通率在＜4h时间段比较两组结果相似，而冠脉总再通率在COPD组（51．79％）低于非COPD组（63．42％），但无显著差异（P＞0．05）；住院期间并发肺部感染、胃出血的发生率在COPD组显著高于非COPD组（P＜0．01），而并发心律失常、心绞痛的发生率在两组间无显著差异（P＞0．05）；COPD组（17．86％）与非COPD组（9．80％）的住院期间病死率比较无显著差异（P＞0．05）。结论：COPD并AMI患者对溶栓的耐受性良好，静脉溶栓的效果与非COPD组相近。缩短开始溶栓的时间是提高冠脉再通率，改善预后的关键。

Observation of the Thrombolysis in Patients of Chronic Obstractive Pulmonary Disease with Acute Myocardial Infarction

Objective: To observe and enaluate the efficacy of thrombolysis and its influence on prognosis in COPD patients with AMI. Methods: Clinical data of 179 AMI patients with thrombolysiz Collected and divided into two groups: 56 COPD cases and 123 none COPD cases. Coronary artery reperfusion rate and complication and mortality were abserved. Results: Coronary artery reperf usion rate after treatment with thrombolysis of resuct were similar in four hour, but coronary artery total reperf usion rate of COPD (51.79%) was lower than none COPD (63.42%), there were not significant differences (P> 0.05) between two groups, Incidence of lung infection and gastrorrhagia in COPD was higher than none COPD (P<0.01)while in hospital. There were not significant differences (P >0.05), Arrhythmia and angina pectoris in two groups mortality in COPD (17.86%) and none COPD(9.8%) significanly different (P>0.05) while in hospital. Conclusion: Patients with COPD and AMI were good at the effect of treatment with thrombolysis of bearing is similar with none COPD. It is the key for increase coronary artery reperfusion rate and improve prognosis if shorten the time of thrombolysis starting.