尿激酶溶栓治疗急性心肌梗死成功后相关冠状动脉形态动态观察

目的:观察急性心肌梗死(AMI)尿激酶溶栓成功后相关冠状动脉(冠脉)形态动态改变。方法:以溶栓成功的42例患者为观察对象,溶栓后90min和6个月时分别对其进行冠脉造影,然后用计算机辅助定量冠脉造影系统对溶栓后的冠脉病变处进行测量。结果:溶栓后90min42例患者中5例残余狭窄为90%～95%,32例残余狭窄为70%～90%,4例残余狭窄<50%,1例无明显狭窄;与溶栓后90min相比较,溶栓后6个月时34例患者残余狭窄无明显改变(P>0.05),7例残余狭窄明显改善(P<0.05)。结论:AMI静脉溶栓虽可挽救一部分濒临坏死的心肌,但大部分相关冠脉仍留有明显的残余狭窄,仍需行经皮冠脉介入术来解决残余狭窄问题。

Dynamic morphologic changes of infarct-related coronary artery in patients with acute myocardial infarction after successful intravenous thrombolysis with urokinase

Objective:To observed dynamic morphologic changes of infarct-related coronary artery in patients with acute myocardial infarction after successful intravenous thrombolysis with urokinase. Method:Forty-two patients were included in the study. Coronary arteriography was performed at the 90 th minute and the 6 th month after thrombolysis and coronary artery stenosis was assessed by quantitative coronary angiography (QCA).Result:After thrombolysis at 90 th minute, detected the residual stenosis 90%~95% in 5 patients , 70%~90% in 32 patients and less than 50% in 4 patients. Only one patient shows no significant residual stenosis. At 6 th month, the residual stenosis was not significantly improved in 34 cases (P> 0.05) and significantly improved in 7 cases (P< 0.05). Conclusion:Intravenous thrombolysis can rescue dying myocardium, but residual stenosis are determined in most patients. Percutaneous coronary intervention (PCI) should be performed to improve the residual stenosis. To ameliorate the residual stenosis should be achieve through lifestyle changes and reasonable medication therapy.