急性心肌梗死再灌注治疗的临床分析

目的 探讨急性心肌梗死患者接受不同再灌注治疗的特点及近远期疗效。方法 回顾性分析2000年1月～2004年5月期间281例ST段抬高急性心肌梗死患者分别接受直接冠状动脉成形术、静脉溶栓、补救性冠状动脉成形术、冠状动脉搭桥治疗，比较接受不同再灌注治疗患者的临床特征、心肌梗死、再灌注治疗时间、冠状动脉病变特点、住院及随访期间不良心血管事件发生情况。结果 接受静脉溶栓、直接冠状动脉成形术、补救性冠状动脉成形术、冠状动脉搭桥治疗患者分别为51例、182例、34例、14例，接受再灌注治疗以男性为主，常伴有糖尿病史，补救性冠状动脉成形术组年龄偏小。心肌梗死部位无差异性，发病至入院时间无差异性，入院至再灌注治疗时间有显著性差异（P〈0.001）。冠状动脉造影示直接冠状动脉成形术组、补救冠状动脉成形术组、冠状动脉搭桥组梗死相关动脉分布、狭窄程度、病变类型无明显差异（P〉0.05），病变血管数有明显差异（P〈0．001），梗死相关动脉再通率有显著性差别（P〈0．001）。住院期间仅直接冠状动脉成形术组有4例行再次血运重建，四组患者再发心绞痛发生率无差异性，但四组患者死亡率有显著性差异。21例患者失访，随访期间四组患者再发心绞痛、再发心肌梗死、病死率均无显著性差异，直接冠状动脉成形术组因支架内再狭窄分别有6例和9例进行冠状动脉搭桥术和切割球囊＋支架植入术。结论 对急性心肌梗死患者实施不同再灌注治疗是安全有效的，应重视对合并心源性休克患者开展直接冠状动脉成形术和急症冠状动脉搭桥术。直接冠状动脉成形术组再次血运重建率高（8．2％），应用药物洗脱支架有望进一步改善预后。

Analysis of the Clinical Effect of Reperfusion Therapies in Acute Myocardial Infarction Patients

Aim To analyze the clinical effect of reperfusion therapies on ST-segment elevation acute myocardial infarction(AMI) during hospitalization and follow-up.Methods Two hundred and eighty-one patients with ST-segment elevation AMI were treated by primary percutaneous coronary intervention(PCI),fibrinolytic, rescue PCI or coronary artery bypass graft(CABG).The clinical and angiographic characteristics were analyzed.Major adverse cardiac events(MACE) were assessed during hospitalization and follow-up period.Results 182,51,34 and 14 patients received primary PCI,fibrinolytic,rescue PCI and CABG respectively.There were no siginificant differences in time from onset of symptom to hospital admission,infarct related artery(IRA),culprit lesion type and stenosis degree among four groups.However,there were siginificant differences in age,diabetic history,time from hospital admission to reperfusion therapy,multivessel diseases and patency rate of IRA among four groups.The incidences of recurrent angina and target vessel revascularization were not different among four groups during in-hospital period,but cardiac mortality was significantly different among four groups during in-hospital period.During follow-up period,there were no significant difference in recurrent angina,myocardial infarction and cardiac death among four groups,but 15 patients suffered from stent restenosis and received revascularization in primary PCI group(P<0.001).Conclusions Reperfusion therapy is a safe and effective therapeutic maneuver for patient with AMI,moreover,primary PCI or emergency CABG may be more preferable in cardiac shock patients.The introduction of drug eluting stents is able to dramatically reduce the rate of in-stent restenosis.