冠脉内超声溶栓对急性心肌梗死患者胸痛、心电图和心肌酶学的影响

目的 通过研究冠脉内超声溶栓对急性心肌梗死患者胸痛、心电图和心肌酶学的影响以探讨经导管超声溶栓挽救成活心肌的意义.方法 入选急性心肌梗死患者56例(前壁心肌梗死30例,下壁心肌梗死26例).分组:超声溶栓后梗死相关血管血流达TIMI3级为溶栓成功组(A组=20例);超声溶栓后梗死相关血管血流达不到TIMI3级而后行PTCA达TIMI3级为超声溶栓+PTCA组(B组=16例);单行PTCA后梗死相关血管血流达TIMI3级为PTCA成功组(C组=20例).结果 各组发病到来院时间、来院进手术室时间和进手术室到血管开通时间均无差异.A组和B组所有患者全部达临床再通和冠脉造影再通标准,冠脉造影再通标准与临床再通标准相关性好.C组中90%患者胸痛缓解50%以上,80%患者ST段下降50%以上,100%患者心肌酶峰提前.结论低频高能超声可有效地溶解梗死相关血管内的血栓,挽救成活心肌.但超声溶栓加PTCA可能有更高的血管开通率,可挽救更多的成活心肌.

The Effects of Coronary Ultrasound Thrombolysis on The Chest Pain , ECG and Myocardial Enzymes in Patients with Acute Myocardial Infarction

Objective This study was conducted to evaluate the role of coronary ultrasound thrombolysis (CUT) in saving the myocardium in AMI. Methods Consecutive patients (n = 56) with evidence of anterior AMI(n = 30) and inferior AMI(n = 26) were studied. The patients were divided into 3 groups. Group A: 20 cases had TIMI ( Thrombolysis In Myocardial Infarction) grade 3 fiow in the infarct-related vessels following CUT. Group B: In 16 cases TIMI-3 grade wasn't flow in the infarct-related vessels was not achieved by CUT, But achieved after rescue PTCA. Group C : 20 cases had primary PTCA. Results There was no difference in the time from onset to hospital and that from door to reperfusion among the three groups. All patients had clinical reperfusion in group A and B. In group C. more than 50% chest pain relieved in 90% patients,more than 50% ST segment reduction were seen in 80% patients and myocardial enzymes peaks were advanced in 100% patients. Conclusions The result suggested that CUT could dissolve the thrombi in infarct-related vessels in patients with AMI. It could save more myocardium than regular primary PTCA.