急性心肌梗塞尿激酶静脉溶栓的临床观察

目的:探讨尿激酶静脉溶栓治疗急性心肌梗塞的效果。方法:60例急性心梗塞(AMI)患者应用尿激酶作静脉溶栓治疗,以60例未进行溶栓治疗的AMI患者作对照,比较两组临床疗效、血管再通、不良反应、近期病死率的差异。结果:溶栓组血管再通率66．7％,明显高于未溶栓的对照组(53．3％),4周死亡率明显少于对照组(P均< 0．01);溶栓距发病时间<6 h者的血管再通率、4周死亡率也明显优于对照组(P<0．05);尿激酶150万U的血管再通率、4周死亡率明显优于尿激酶100万U(P<0．05)。两组不良反应无显著差异,尿激酶两种剂量的不良反应亦无显著差异(P>0．05)。结论:尿激酶静脉溶栓是治疗急性心肌梗塞的一种有效手段。     

急诊直接冠脉介入治疗急性心肌梗塞的临床价值

目的:探讨急诊直接经皮冠状动脉介入治疗(PCI)对急性心肌梗塞(AMI)患者近期及远期预后的影响。方法:65例初次AMI患者被随机分为两组:直接PCI组(A组,35例)及静脉溶栓成功组(B组,30例)。比较分析住院及随访期间两组主要临床事件发生率。结果:(1)住院期间直接PCI组的平均住院天数(d)、出血率(%)、再发不稳定心绞痛(%)、非致死心肌梗塞(%)、心源性死亡率(%)明显低于溶栓组(P<0.01);(2)随访期直接PCI组左室扩大(%)、室壁瘤形成(%)、死亡(%)、再狭窄率(%)等发生率亦显著低于溶栓组(P<0.01),存活率(%)及射血分数(%)明显高于溶栓组(P<0.05~<0.01)。结论:急诊直接PCI治疗是早期再灌注安全有效的方法,对于提高再通率、减少并发症及改善心功能优于溶栓组。     

心肌梗死溶栓后心室晚电位、心率变异性、左室射血分数及血脂的变化

为了解急性心肌梗塞(AMI)溶栓后心室晚电位(VLP)、心率变异性(HRV)、左室射血分数(LVEF)及血脂的变化,本文对102例AMI患者进行静脉溶栓后,分为再通组69例与未通组33例,测定溶栓后及半年的VLP、HHV、LVEF及血脂,结果显示上述指标再通组与未通组之间有显著性差异(P<0.01),再通组内上述指标有显著性差异(P<0.01),未通组内无统计学差异(P>0.05),提示AMI溶栓治疗可以改善上述4项指标,降低死亡率,是一项行之有效的治疗方法。     

参芪扶正注射液对心肌再灌注损伤的影响

目的：探讨参芪扶正注射液对急性心肌梗死(AMI)静脉溶栓治疗后再通及并发症的影响。方法：选择82例住院的AMI病人，随机分为治疗组和对照组，治疗组在溶栓治疗的同时静脉输入参芪扶正注射波250ml，每日1次，连用3周后比较两组再通标准各项指标及并发症情况。结果：两组再通标准指标中，再灌注心律失常发生率治疗组为55.56％，明显低于对照组82.86％，两组比较有统计学意义(P＜0.05)；心力衰竭及梗死后心绞痛发生率均明显低于对照组(P均＜0.05)；休克及总病死率也均低于对照组。结论：参芪扶正注射液不仅为补气要药，同时对心脏块血再灌注损伤有保护作用。     

静脉溶栓治疗对糖尿病并发急性心肌梗死患者近远期效果的影响

目的:本研究探讨静脉溶栓治疗对糖尿病并发急性心肌梗死(AMI)患者近远期效果的影响。方法:对本院连续住院治疗的116例AMI的溶栓治疗患者,按临床诊断分成糖尿病组(n=26)、非糖尿病组(n= 90)。根据胸痛症状、心电图ST段抬高和下降情况及心肌酶水平峰值变化,采用中华医学会心血病学分会制定的间接标准及其组合判断方法评定梗塞相关血管是否再通,随访观察和分析2组治疗效果。结果:开始溶栓时间:糖尿病组平均为(5.69±2.24)h,非糖尿病组平均为(4.68±1.80)h,两组比较糖尿病组时间延长,有显著性差异(P<0.05)。梗塞血管再通:糖尿病组有13例,再通率为56.5%,非糖尿病组66例,再通率为75.9%,两组再通率相比,糖尿病组明显低于非糖尿病组,有显著性差异(P<0.025)。心力衰竭发生率在糖尿病组溶栓后有42.3% (11例),非糖尿病组21.1%(19例),两组发生率比较糖尿病组严重心力衰竭的发生率高于非糖尿病组,有显著性差异(P<0.05)。住院病死率在糖尿病组死亡5例(占19.2%),非糖尿病组死亡9例(占10.0%),两组相比,糖尿病组死亡率有增多趋势,但尚无显著性差异(P>0.05)。平均随访5.6年(2.2～7.5年),糖尿病组病死率高于非糖尿病组(P<0.05)。结论:糖尿病并发急性心肌梗死患者经溶栓治疗后,仍有较差的近期及远期预后,其溶栓治疗再通率较低,与糖尿病患者开始溶栓时间延迟有关。     

半量瑞替普酶溶栓治疗75岁以上急性心肌梗死疗效及安全性比较

目的:探讨半量瑞替普酶(r-PA)溶栓治疗对75岁以上的急性心肌梗死(AMI)患者的疗效及安全性.方法:选择75岁以上的AMI患者53例,将其随机分为溶栓组和常规组,分别接受半量r-PA溶栓及常规药物治疗,比较2组患者2 h血管再通率、30 d内主要的心血管事件及出血等并发症有无差异.结果:溶栓组2 h冠状动脉再通率72.0%,常规组为25.0%,P<0.01;30 d内病死率溶栓组为8.0%,常规组为32.1%,P<0.05;溶栓组的主要心血管事件的发生明显低于常规治疗组,P<0.05.溶栓组出血发生率为36.0%,常规组为10.7%,P<0.05,但均为轻度出血.结论:半量r-PA治疗75岁以上的AMI患者安全有效.     

静脉溶栓对急性心肌梗死治疗效果的多因素分析

目的探讨影响静脉溶栓(TT)治疗急性心肌梗死(AMI)临床疗效的因素,提高TT治疗水平。方法用logistic回归分析AMI患者TT治疗时间、年龄、梗死部位等11个因素与疗效的关系。比较AMI起病后6、12h内TT组间以及各组与同时段急诊经皮冠状动脉介入治疗(PCI)疗效差异。结果梗死血管再通并存活且无严重溶栓并发症者,TT治疗时间中位数为4h;未再通或死亡或有严重溶栓并发症者TT治疗时间中位数为8h(P<0.01)。TT治疗时间进入回归方程。其他各因素未能进入回归方程。TT组间比较,6h组心绞痛持续时间短为2.41h(P<0.05);再通率、净有效率高分别为75%,69.04%;病死率、心衰发生率分别为12.2%,7.9%,低于12h组的25%,16.7%。与同时段PCI比较,净有效率6h TT组为69.1%,PCI组为80.4%(P>0.05),12hTT组为33.3%、PCI组为81.3%(P<0.05)。结论年龄、性别、高血压史、梗死部位等因素与溶栓疗效无明显关联。治疗时间是影响TT临床疗效的最主要因素,缩短AMI发作至接受治疗的时间是提高TT治疗率和临床疗效的关键。     

急性心肌梗塞溶栓治疗对患者近远期预后的影响

本文对157例静脉溶栓治疗及70例未溶栓的急性心肌梗塞(AMI)患者近远期预后进行研究.溶栓组中冠状动脉再通130例,未通27例.结果显示,溶栓再通组住院期间病死率明显低于未通组门(3.8%比12.9%,P相似文献   

急性心肌梗死患者外周血单核细胞水平对预后的影响

目的探讨急性心肌梗死(AMI)患者外周血单核细胞水平变化对预后的影响。方法对2005年6月—2007年6月162例AMI患者进行分析,于入院即刻查血常规和肌酸激酶(CK)、肌酸激酶同工酶(CK-MB),并尽早接受静脉溶栓治疗,于入院2周内行超声心动图检查,依单核细胞水平分为增高组和正常组,并记录溶栓开通情况及住院期间心脏事件发生情况,评价外周血单核细胞增多对AMI患者预后的影响。结果增高组CK、CK-MB峰值较正常组增高(P<0.05)心力衰竭发生率为42.1%,严重心律失常发生率为21.1%,梗死后心绞痛发生率为21.1%,病死率为13.1%均明显高于正常组(P<0.05或P<0.01)。溶栓后临床指标再通患者增高组射血分数(LVEF)和左室短轴缩短率(FS)均低于正常组(P<0.05);而左室收缩末容积(LVESV)和左室舒张末容积(LVEDV)明显高于正常组(P<0.05)。结论单核细胞增高与AMI临床预后有关,可能成为判断AMI近期预后的重要指标。     

急性心肌梗死早期尿激酶静脉溶栓的临床研究

目的观察急性心肌梗死(AMI)早期尿激酶静脉溶栓的临床疗效。方法 32例AMI患者早期给予尿激酶静脉溶栓治疗与55例AMI患者给予常规治疗,观察溶栓治疗患者的再通情况及其溶栓后24h内T波倒置对判定冠脉再通的意义。结果溶栓组与对照组溶栓开始时间距发病6h的冠脉再通率分别为76.0%和16.4%,差异有统计学意义(P0.05)。发病至开始溶栓时间越短,再通率越高。早期溶栓24h内T波倒置提示冠脉再通,早期T波倒置与冠脉再通率有明显相关性(P0.01)。结论急性心肌梗死早期使用尿激酶溶栓治疗可提高AMI的疗效,降低病死率。ST-T改变和T波倒置具有判断闭塞冠脉再通的临床价值。     

AMI患者尿激酶与组织型纤溶酶原激活剂治疗结果的对比

比较31例尿激酶(UK)及14例组织型纤溶酶原激活剂(t-PA)静脉溶栓辅以阿斯匹林及肝素治疗急性心肌梗塞(AMI)的疗效.t-PA组与UK组相比较:血管再通率分别为78.6%与58.1%(P>0.05);脑、消化道及呼吸道出血并发症在t-PA组稍多,而UK组以局部皮肤出血较多.血管再通组心力衰竭、严重性心律失常、室壁瘤及梗塞后心绞痛的发生率较低,但两组间均无显著性差异;再通组病人心脏破裂的发生明显低于未再通组(0与17.6%P<0.05).本研究提示静脉t-PA溶栓治疗血管再通率高于静脉UK,有条件者可以首选t-PA.溶栓再通可以减少心力衰竭、室壁瘤、心梗后再缺血的发生,特别是心脏破裂的发生,从而改善病人的预后.     

凝血及纤溶系统变化在急性心肌梗塞溶栓治疗中的作用

本文通过对急性心肌梗塞(AMI)早期溶栓治疗的43例患者进行凝血及纤溶系统功能的测定,分别在溶栓前、溶栓后4h、12h、24h、48h及1周测定凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤溶酶原(PLG)、α_2抗纤溶酶(α_2AP)、纤维蛋白原(Fg)、D二聚体含量(D=Dimer)、组织型纤维溶酶原活化物(t-PA)、组织型纤溶酶原活化物抑制物(PAI),其结果显示,溶栓组冠脉再通26例(60.5%),溶栓前与溶栓后4h相比冠脉再通组t-PA活性明显高于未通组(P<0.01),PLG活性及Fg含量的降低幅度再通组明显高于未通组,建议溶栓中应把测定t-PA、PAI、PLG及Fg作为判断溶栓治疗效果的指标.     

急性心肌梗死后左心室收缩功能的定量组织速度成像分析

目的:应用定量组织速度成像技术(QTVI)测定急性前壁心肌梗死(MI)后不同时段左室的收缩功能,评价再灌注治疗对急性前壁MI患者左室收缩功能的短期影响。方法:对60例初次急性前壁MI患者[心梗后再灌注治疗28例,未再灌注治疗(未再通)32例]和年龄匹配的健康人25例应用QTVI技术分别测量二尖瓣环的收缩期峰值运动速度,计算平均峰值速度(Sa)。通过Simpson方法测定并计算左室射血分数(LVEF)、左室短轴缩短率(FS)。急性前壁MI患者分别于发病后第2、4、12周进行上述测量。比较分析再灌注治疗对急性心肌梗死(AMI)患者左室收缩功能的短期影响。结果:Sa与LVEF呈显著正相关(r=0.76);AMI患者发病后第2、4、12周的Sa、LVEF、FS均低于对照组(P<0.01);再灌注组的Sa、LVEF、FS均显著优于未再通组(P<0.05-<0.01)。结论:QTVI测量二尖瓣环峰值运动速度能很好地反映左室整体收缩功能;及时有效的再灌注治疗可明显改善左室收缩功能。     

右室心肌梗死对急性下壁心肌梗死临床特征和预后的影响

目的：分析右室心肌梗死(心梗)对急性下壁心梗临床特征和预后的影响。方法：比较急性单纯性下壁心梗(第一组)和急性下壁心梗合并右室心梗(第二组)两组患的临床特征和院内病死率。结果：共176例患符合入选条件，第一组115例，第二组61例。第一组低血压、快速心律失常(包括阵发性室上性心动过速，阵发性心房颤动，领发室性早搏，室性心动过速，心室纤颤等)、缓慢心律失常(包括窦性心动过缓，房室传导阻滞)、心功能不全的发生率和院内病死率显低于第二组(P＜0．05)。静脉溶栓、急诊PTCA和未行再灌注治疗的院内病死率在第一组的分别为3．23％，3．33％和29．17％，在第二组分别为9．25％，13．04％和82．35％。结论：当急性下壁心梗合并右室心梗时，患的临床表现更为严重，院内病死率增高。积极行溶栓或急诊PTCA治疗，可显降低其院内病死率.     

急性心肌梗死急诊经皮冠状动脉介入治疗后 ST段变化与临床预后的关系

目的 研究急性心肌梗死(AMI)成功急性介入术后ST段变化与临床预后的关系。 方法 回顾分析45例AMI患者的临床及造影情况,记录住院时、急诊介入术后90分钟、6小时、12小时、24小时12导联心电图,化验心肌CK值。介入治疗后在90分钟内抬高ST段回落>50％,CK峰值在12小时内,24小时内T波反转作为灌注组,不符合上述条件者为无灌注组。 结果45例AMI患者中36例(80％)再灌注,无再灌注组9例(20％);前壁心肌梗死无灌注组7例、而心肌再灌注组下壁心肌梗死20例。充血性心力衰竭、死亡,灌注组5例,无灌注组5例。 结论 AMI成功急性介入术后ST段变化与微循环障碍及住院期间的临床预后密切相关。     

高龄老年急性心肌梗死特点

目的 比较分析不同年龄段的急性心肌梗死(AMI)患者的临床特点.方法 选取2015年1月～2020年12月入住湖北省中西医结合医院的AMI患者812例,根据患者年龄分为非高龄老年组(＜75岁)468例和高龄老年组(75 ～89)岁344例.收集2组患者基线资料、发病时症状和体征、实验室检查、治疗措施等,比较2组所收集的...     

急性右心室心肌梗死的临床特点及预后分析

目的 对急性下壁心肌梗死住院患者的临床资料进行分析,观察合并右心室梗死对病情和转归的影响,并探讨早期再灌注治疗对预后的作用.方法 急性下壁心肌梗死患者304例,其中单纯下壁心肌梗死232例,合并右心室梗死72例,记录一般资料、并发症、实验室检查和治疗情况.结果 右心室梗死组心源性休克、机械并发症、完全性房室传导阻滞、心室颤动、持续性室速和再梗死均明显增高.单纯下壁心肌梗死组病死率为8.6%,右心室梗死组病死率为34.7%.右心室梗死组进行再灌注治疗者病死率为27.8%,保守治疗者病死率为55.6%.结论 右心室梗死作为急性心肌梗死的高危亚组,其严重并发症和病死率显著增加.通过早期再灌注治疗能显著降低右心室梗死的住院期病死率,改善预后.     

Long-term follow-up of patients treated with intracoronary thrombolysis or percutaneous transluminal coronary angioplasty for acute myocardial infarction]

Long-term follow-up data concerning coronary patients treated for acute myocardial infarction with intracoronary thrombolysis (ICT) or percutaneous transluminal coronary angioplasty (PTCA) are sparse. In this study, the early and long-term outcomes in 95 patients undergoing only ICT (group I) and 190 patients undergoing only PTCA (group II) were retrospectively evaluated. Cardiogenic shock cases in group II were excluded from this study because of the absence of comparable shock cases in group I. The overall in-hospital mortality was 3.5% (10 patients). Treatment by reperfusion therapy during the acute phase was not a significant factor in predicting the in-hospital mortality (5.4% in group I vs 2.6% in group II), but a Forrester subset (p < 0.001) and the extent of coronary artery disease (p < 0.05) were reliable predictors. In a discrimination analysis, a Forrester subset (3, 4) was the most reliable predictor followed by age (> 70 years). Follow-up was completed for 263 of 273 (96%) hospital survivors (88 patients in group I and 185 in group II). Mean follow-up periods of groups I and II (+/- SD) were 57 +/- 35 and 23 +/- 15 months, respectively. Five-year cardiac death-free survival for hospital survivors after ICT was 87% compared with 96% after PTCA (p was not significant). In a univariate analysis, a Forrester subset (p < 0.001) and the extent of residual coronary disease on discharge from the hospital (p < 0.01) were reliable predictors of subsequent cardiovascular deaths. Multivariate analysis also identified these 2 factors as independent predictors. We concluded that the most significant determinant factor of in-hospital and long-term mortality after intervention might be a Forrester subset; namely, left ventricular function at the time of emergency admission, and that long-term survival seemed to relate to the extent of coronary artery disease on discharge from the hospital. This suggested that interventional reperfusion therapy did not necessarily improve left ventricular function at the time of hospital discharge.     

Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: effect on in-hospital mortality and left ventricular function

To determine the effect of treatment of recurrent ischemia after reperfusion for acute myocardial infarction on in-hospital mortality and left ventricular function recovery and to identify patients at highest risk of serious consequences in the event of recurrent ischemia in this setting, 405 consecutively treated patients were studied retrospectively. All patients received intravenous thrombolytic therapy within 6 h of ST segment elevation-documented infarction and had angiographic confirmation of their reperfusion status performed within 120 min of treatment. Three hundred three patients had successful reperfusion with or without rescue angioplasty and had no recurrent ischemia (group 1), 74 patients had initially successful reperfusion but subsequent recurrent ischemia (group 2) and 28 patients had failed reperfusion (group 3). The in-hospital mortality in groups 1 to 3 was 2.0%, 14.9% and 32.1%, respectively (p less than 0.001) and the change from baseline to prehospital discharge left ventricular ejection fraction was 1.2 +/- 9.3%, -0.8 +/- 8.7% and -4.3 +/- 5.3%, respectively (p = NS). Within the recurrent ischemia group (group 2), multiple regression analysis found absence of cardiogenic shock at presentation (p = 0.002) and successful treatment initiated within 90 min of recurrent ischemia (p = 0.045) to be the only variables independently correlated with in-hospital survival. Later successful reperfusion was not associated with improved hospital survival. The timing and success of treatment did not affect recovery of global or regional left ventricular function in the patients with paired angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early sustained ventricular arrhythmias complicating acute myocardial infarction

Objective

Sustained ventricular arrhythmias complicate 2% to 20% of acute myocardial infarctions (MIs) and are associated with increased in-hospital mortality. However, it remains unclear whether successful mechanical revascularization improves outcomes in these patients. The objective of this analysis was to identify predictors of sustained ventricular arrhythmias after acute MI and to determine the influence of successful revascularization on in-hospital mortality.

Methods

We conducted a retrospective cohort study of all patients who underwent percutaneous coronary intervention for acute MI in New York State between 1997 and 1999.

Results

Of the 9015 patients who underwent percutaneous coronary intervention for acute MI, 472 (5.2%) developed sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) before revascularization. After multivariable adjustment, independent predictors of sustained VT/VF included cardiogenic shock (odds ratio [OR], 4.10; 95% confidence interval [CI], 3.20-5.58; P <.001), heart failure (OR, 2.86; 95% CI, 2.24-3.67: P <.001), chronic kidney disease (OR, 2.58; 95% CI, 1.27-5.23; P = .009), and presentation within 6 hours of symptom onset (OR, 1.46; 95% CI, 1.18-1.81; P = .001). Patients with sustained VT/VF had greater in-hospital mortality (16.3% vs 3.7%, P <.001). Although successful percutaneous coronary intervention was associated with decreased in-hospital mortality in patients with VT/VF (P <.001), patients with sustained VT/VF and successful revascularization experienced increased mortality compared with patients without sustained ventricular arrhythmias (P <.001).

Conclusion

Among patients undergoing percutaneous coronary intervention for acute MI, sustained VT/VF remains a significant complication associated with a 4-fold increased risk of in-hospital mortality. Early mortality is reduced after successful percutaneous coronary intervention, but remains elevated in this high-risk group.