直接经皮冠脉介入和静脉溶栓治疗急性心肌梗死的比较

目的　探讨直接经皮冠脉介入 (PCI)和静脉溶栓治疗急性心肌梗死 (AMI)的临床疗效。方法　采用不同时期连续 13个月收治AMI患者 ,静脉溶栓组 5 7例 ,直接PCI组 75例。比较两组的再灌注率 ,以及两组住院和随诊期间心脏事件发生的情况。结果　静脉溶栓组再灌注率为 5 7.9% ,直接PCI组为 96 %。超声心动图LVEF值静脉溶栓组和直接PCI组分别为 0 .5 9± 0 .12和 0 .6 3± 0 .10。两组在住院期间的心脏事件的发生率无显著差异 ,而随访期间的心脏事件的发生率有显著差异 :直接PCI和静脉溶栓的不稳定心绞痛发生率分别为 9.3%和 38.6 % ;非致死性心功能衰竭 4 .0 %和 14 .0 % ;病死率 0 %和 7.0 % ;复合终点事件 9.3%和 5 0 .9%。结论　直接PCI能更快、更满意地开通梗死相关血管 ,抢救濒临死亡的心肌 ,改善心功能 ,降低病死率 ,优于静脉溶栓治疗。

The comparison between primary PCI and venous thrombolysis on acute myocardial infarction

Objective To compare primary PCI with venous thrombolysis on the clinical effect in patients with AMI. Methods One hundred and thirty two consecutive patients with acute myocardial infarction during thirteen months were divided into primary PCI group( n =75) and venous thrombolysis group(n=57).The reperfusion rate and cardiac events during in hospital and follow up were recorded in two groups. Results The reperfusion rate of venous thrombolysis was 57.9% and 96% in primary PCI group( P <0.01). LVEF were 0.59+0.12 and 0.63+0.10 ( P <0.05) respective in two groups. There was no significant difference in cardiac events of in hospital in two groups, but during follow up period, the unstable angina (9.3% vs 38.6%, P <0.01) , non fatal heart failure (4.0% vs 14.0%, P <0.05), mortality rate (0% vs 7.0%, P <0.05) and composite events (9.3% vs 50.9%, P <0.01) were decreased significantly in primary PCI group than in venous thrombolysis group .Conclusions Primary PCI open the infarct related vessel more faster and satisfied than venous thrombolysis, and is better than venous thrombolysis in improving cardiac function and decreasing mortality rate.