急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通过长期预后的影响

为探讨急性心肌梗塞溶栓治疗梗塞相关冠瘃动脉再通过长期预后的影响。自１９９１年７月至１９９５年１月按本课题研究方案对急性心肌梗塞溶栓治疗急性期生存出院的患者作为研究对象，血管再通按临床再通标准判定。本课题组３６所医院共随诊了１２６７例，其中再通组８４３例，平均随诊１６．０±１０．４个月，未组４２４例，平均随诊１９．２±１２．２个月。以死亡作为终点或随诊截止于１９９５年３月底。血管再通组不通组相比（１     

急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对长期预后的影响(1267例长期随诊)

为探讨急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对长期预后的影响。自１９９１年７月至１９９５年１月按本课题研究方案对急性心肌梗塞溶栓治疗急性期生存出院的患者作为研究对象。血管再通按临床再通标准判定。本课题组３６所医院共随诊了１２６７例，其中再通组８４３例，平均随诊１６．０≤±１０．４个月，未通组４２４例，平均随诊１９．２±１２．２个月。以死亡作为终点或随诊截止于１９９５年３月底。血管再通组与未通组相比：（１）心脏原因死亡分别为２．８５％与４．７２％（时序检验Ｐ＞０．１）；（２）Ｋａｐｌａｎ－Ｍｅｉｅｒ曲线３年生存率分别为９１．６％和７３．９％（时序检验Ｐ＜０．００１）；（３）再梗塞发生率分别为５．６９％和５．９０％，两者相近；（４）１２６７例Ｃｏｘ回归模式对随访生存分析结果，血管再通是独立因素，较未通者生存机会增加３３．５％，复发再梗塞１次减少生存机会３６．５％。年龄和梗塞部位也是独立因素。     

急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对长期预后的影响（1267例长期随诊）

为探讨急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对长期预后的影响。自１９９１年７月至１９９５年１月按本课题研究方案对急性心肌梗塞溶栓治疗急性期生存出院的患者作为研究对象。血管再通按临床再通标准判定。本课题组３６所医院共随诊了１２６７例，其中再通组８４３例，平均随诊１６．０±１０．４个月，未通组４２４例，平均随诊１９．２±１２．２个月。以死亡作为终点或随诊截止于１９９５年３月底。血管再通组与未通组相比：（１）心脏原因死亡分别为２．８５％与４．７２％（时序检验Ｐ＞０．１）；（２）Ｋａｐｌａｎ－Ｍｅｉｅｒ曲线３年生存率分别为９１．６％和７３．９（时序检验Ｐ＜０．００１）；（３）再梗塞发生率分别为５．６９％和５．９０％，两者相近；（４）１２６７例Ｃｏｘ回归模式对随访生存分析结果，血管再通是独立因素，较未通者生存机会增加３３．５％，复发再梗塞１次减少生存机会３６．５％。年龄和梗塞部位也是独立因素。     

急性心肌梗塞溶栓再通的临床标准与冠脉造影的对比研究

我院对四年来收入的７８例急性心肌梗塞（ＡＭＩ）患者进行静脉溶栓治疗。作者以冠状动脉造影结果为标准，对ＡＭＩ溶栓治疗再通临床标准（参考方案）进行了验证。结果：参考方案的灵敏度为７０．２％，特异性６７．７％，阳性预测值７６．７％，阴性预测值６０．０％，临床准确度６９．２％。提示：参考方案与冠状动脉造影结果有较好的相关性，判定再通的准确性较高。     

急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对急性期预后的影响（1138例观察分析）

为探讨急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通对急性期预后的影响。课题组于１９９３年５月至１９９５年１月收治的急性心肌梗塞溶栓治疗患者１１３８例，采用临床指标判断血管再通的标准。１１３８例中，再通者７５７例（６６．５％），未通者３８１例（３３．５％）。血管再通组与未通组比较：４周病死率分别为３．４％和２１．８％（Ｐ＜０．００１）；各种严重并发症前组显著低于后组（Ｐ＜０．０１－０．００１）。Ｃｏｘ回归模式４周死亡风险分析，血管未通者的死亡风险是已通者的６．６９倍，血管再通与否是最重要独立因素。从单因素和多因素分析都提示梗塞相关血管再通，对改善心肌梗塞急性期预后起十分重要的作用。     

急性心肌梗塞静脉溶栓再通的临床指征与冠状动脉造影的对比研究

对100例急性心肌梗塞患者行静脉溶栓治疗,以冠状动脉造影结果为标准,探讨参考方案及临床指征判定冠脉再通的价值及意义.结果:参考方案的敏感性为91.8%,特异性为70.6%,临床准确度为81.0%.说明参考方案与冠状动脉造影有很好的相关性,判定冠状动脉再通的准确性很高.在各项临床指征中,酶峰值提前的特异性最高.溶栓后≤1小时终末T波倒置可单独做为极早期判定冠状动脉再通的指征.     

冠状动脉再通临床标准与冠状动脉造影的对比研究

目的：了解溶栓治疗后冠状动脉再通的临床标准的准确性。方法：以冠状动脉造影为标准，对冠状动脉再通的临床标准进行双盲诊断试验研究。７３例急性心肌梗死患者在静脉溶栓治疗后２小时内接受冠状动脉造影检查。结果：以《中华心血管病杂志》编委会推荐的参考方案的标准判断４０例再通，３３例未通；以冠状动脉造影判断４４例再通，２９例未通。参考方案标准的敏感度为６８．２％，特异度为６５．５％，临床准确度为６７．１％。结论：目前临床沿用的参考方案的标准是较好的判断标准。试图改变其中某些标准的方法不能增加其敏感度和准确度。在对假阳性及假阴性患者进行分析时发现：ＳＴ段在溶栓治疗后２小时内不能迅速下降是影响其临床准确度的原因；不同类型心律失常预报临床再通的价值不同，且与心肌梗死部位有关。     

急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通过急性期预后的影响

为探讨急性心肌梗塞溶栓治疗梗塞相关冠状动脉再通过对急性期预后的影响。课题组于１９９３年５月至１９９５年１月收治的急性心肌梗塞组溶栓治疗患者１１３８例，采用临床指标判断血管再通的标准。１１３８例中，再通者７５７例（６６．５％），未通者３８１例（３３．５％）。血管再通组与未通组比较，４周病死率分别为３．４％和２１．８％（Ｐ〈０．００１）；各种严重并发症前组显著低于后组（Ｐ〈０．０１－０．００１）。Ｃｏ     

血清肌红蛋白在急性心肌梗塞溶栓再通及梗塞延展中的意义

<正> 临床研究表明急性心肌梗塞(AMI)后梗死心肌内的肌红蛋白(Mb)释放入血明显早于CK及CPK-Mb,因而认为Mb是AMI早期诊断敏感的生化指标.近年来国外学者研究表明Mb也是快速诊断梗塞冠脉再通最可靠的生化指标之一,但国内尚无有关报道,本文测定了我院AMI住院患者应用尿激酶     

急性心肌梗死溶栓后再梗塞的治疗

该研究以1992年GUSTO Ⅰ试验及1998年ASSENT 2试验的急性心肌梗死溶栓治疗后再梗塞的患者为研究对象,比较溶栓治疗、血管成形术(冠脉内血管成形术或外科手术)以及保守抗凝治疗等三种方法治疗溶栓后再梗塞的利弊。 方法 资料来源于GUSTO Ⅰ及ASSENT 2试验中急性心肌梗死溶栓治疗的患     

静脉溶栓冠脉再通对急性心肌梗死生存率的影响

目的：探讨静脉溶栓对急性心肌梗死存活率的影响。方法：对64例经静脉溶栓治疗的患,以临床血管再通为标准,对比分析再通组与未通组的存活率。结果：血管再通组存活率为97．6％,死亡率2．4％,未通组存活率为73％,死亡率27％,结论：急性心肌梗死静脉溶栓治疗是提高生存率的关键。     

Rapid myoglobin analysis to assess coronary artery reperfusion after acute myocardial infarction

Background: Coronary artery reperfusion significantly improves outcome in patients with acute myocardial infarction. A noninvasive method for assessing reperfusion in the early stage of infarction should be helpful in patient management. Hypothesis:We sought to assess whether release pattern of myoglobin is helpful in identifying patients with and without reperfusion following thrombolytic therapy for myocardial infarction. Methods: Myoglobin was measured before thrombolysis, half hourly for 4 h, then every 2 h for 10 h. Myoglobin was analyzed using a ward-based “rapid” and automated analyzer that yielded quantitative results within 10 min of blood collection. Results: In the 15 patients with coronary reperfusion, the time from thrombolysis to peak myoglobin levels (mean ± SD, 2.4 ± 1.5 h) was significantly lower than in nonreperfused patients (5.1 ± 2.9, p < 0.01). As an indicator for reperfusion, a doubling of myoglobin 1 h after streptokinase achieved a sensitivity of 80%, a specificity of 80%, and a predictive accuracy of 80%. Conclusions: The difference in myoglobin release kinetics is useful in identifying patients without coronary reperfusion and should aid in their management.     

Defibrotide versus heparin in the prevention of coronary reocclusion after thrombolysis in acute myocardial infarction

Summary A multicenter controlled study versus heparin was conducted to explore the activity of defibrotide, a polydesoxy-ribonucleotide drug, in preventing reocclusion after urokinase thrombolysis in patients with acute myocardial infarction (AMI). The study involved 137 consecutive patients with AMI and a time from the onset of symptoms 6 hours, treated with urokinase (1,000,000 U intravenous bolus followed by 1,000,000 U slow-drip infusion over 12 hours). Immediately after thrombolysis, patients were allocated to treatment with defibrotide (group D: day 0, 3.6 g by intravenous infusion in 12 hours; days +1 to +6, 800 mg tid intravenously; days +7 to +10/+12, 400 mg tid intramuscularly), or heparin (group H: day 0, 1000 IU/hour infused over 12 hours; days +1 to +10/+12, 5000 IU tid subcutaneously). Coronary angiography was done, whenever possible, at +10/+12 days. The following parameters were assessed: (a) noninvasive estimate of myocardial reperfusion, through the analysis of CPK time-activity curves; (b) incidence of infarct-related artery (IRA) patency (TIMI scores 2–3) at coronary angiography. A total of 125 patients had a complete enzymatic curve (63 in group D and 62 in group H) and 106 had coronary angiography as well. IRA patency (the main end point) was observed in 63% of group D versus 43% of group H patients (p=0.07). No statistically significant differences were found in the proportion of patients with indirect signs of early reperfusion (63% in group D versus 52% in group H patients). Combining the findings of CPK curve analysis and coronary angiographic data, the D group showed a trend towards a minor proportion of patients with reocclusion of a possibly patent IRA (28% vs. 47%) and a greater proportion of patients with late reperfusion of a possibly occluded IRA (44% vs. 37%), in comparison to the H group. These preliminary data suggest that defibrotide is equal, if not more effective than heparin, in combination with urokinase, in achieving IRA patency in patients with AMI.     

急性心肌梗死再灌注损伤临床表现及分析

目的对急性心肌梗死再灌注后出现的特殊临床表现进行分析。方法50例急性心肌梗死患者经静脉溶栓后行冠状动脉造影显示TIMI血流3级。结果再灌注后48例胸痛迅速缓解,2例患者在再灌注后胸痛突然加重;44例患者出现心律失常;40例出现一过性低血压;8例出现一过性ST段抬高。结论冠脉血管再通后绝大部分患者胸痛迅速缓解,且有心律失常发生,一部分患者可出现一过性胸痛加重;一过性低血压也比较常见,可能与多种因素有关;ST段反常性抬高可能是心肌再灌注的指标;溶栓后应进行持续心电和血压监测。     

急性心肌梗死静脉溶栓疗效与血脂相关性

目的 :观察血脂水平对急性心肌梗死 （AMI）患者静脉溶栓治疗效果的影响。方法 :对 3 8例 AMI患者的总胆固醇 （TC）、甘油三酯 （TG）、低密度脂蛋白 -胆固醇 （L DL -C）及高密度脂蛋白 -胆固醇 （HDL -C）于发病后 2 4h内进行测定 ,以中华心血管病杂志编委会 ,AMI溶栓疗法参考方案为标准 ,分为再通组 （3 0例 ） ,未通组 （8例 ）。结果 :溶栓再通组与未通组 TC、L DL -C、HDL -C比较差异无显著意义 ,未通组 TG明显高于再通组 （P<0 .0 5）。结论 :TG水平升高可能影响 AMI患者静脉溶栓效果 ,其机制及临床意义有待于进一步研究     

心肌呈色分级评价急性心肌梗死溶栓疗法的疗效

目的以心肌呈色分级(MBG)评估急性心肌梗死溶栓后的心肌灌注状况.方法89例急性心肌梗死患者给予重组组织型纤溶酶原激活剂治疗.各例于给药后90分钟行冠状动脉造影,观察梗死相关动脉前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率.结果溶栓后符合临床再通标准的为87.6%,未再通的为12.4%.冠状动脉造影结果显示,全组梗死相关动脉的再通率(TIMI 2或3级)为82%;心肌再灌注率(MBG 2或3级)为88.8%,完全再通(TIMI 3级)且完全心肌再灌注(MBG 3级)者为40.4%.6个月死亡率为10.1%.多因素分析结果表明,入院时Killip分级和MBG分级是急性心肌梗死死亡的主要独立预测因子(P=0.0001).结论成功的再灌注治疗应该是梗死相关动脉前向血流TIMI 3级且伴良好心肌灌注.     

ST段抬高型急性心肌梗死溶栓后心电图改变的临床意义

目的通过分析急性心肌梗死抬高的ST段下降幅度,评价溶栓治疗过程中ST段改变对患者心功能的预测价值。方法96例ST段抬高型急性心肌梗死患者,入院后行溶栓治疗,并计算溶栓后2h内ST段抬高振幅总和(ΣSTE)的下降幅度。结果溶栓治疗2h后,ΣSTE较溶栓治疗前下降大于50%时,病人自觉胸痛症状消失,心功能得到较好保护。而ΣSTE较治疗前下降小于50%时,患者心功能不同程度受损。结论ST段抬高型急性心肌梗死的患者经早期溶栓治疗后,其抬高的ST段下降幅度可作为心肌血供能否恢复的间接预测指标,从而能较准确地反映心肌再灌注情况及预测心功能状态。     

QT-interval dispersion in acute myocardial infarction is only shortened by thrombolysis in myocardial infarction grade 2/3 reperfusion

BACKGROUND: Increased QT interval dispersion (QTd) has been found in patients with acute myocardial infarction (AMI). In previous studies this has been shown to decrease with thrombolysis. HYPOTHESIS: The aim of this study was to compare the effects of reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) and by thrombolysis on QTd and correlate these results with the degree of reperfusion. METHODS: We studied 60 patients with a first AMI. The study cohort included 40 consecutive patients who had received thrombolysis (streptokinase or rt-PA); 20 additional consecutive patients with successful primary PTCA, all with preselected Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow by predefined selection criteria (12 stents); and 20 controls. A 12-lead ECG for QTd calculation was recorded before thrombolysis or PTCA and immediately after the procedure. All values were corrected according to Bazett's formula (QTcd). QTd and QTcd values before and after each procedure in three groups and the respective percent changes of deltaQTd and deltaQTcd were compared separately. RESULTS: QTd and QTcd were significantly increased before thrombolysis/PTCA versus normals. An angiogram performed after thrombolysis showed adequate reperfusion (TIMI grade 2/3) in 20 patients, while in the other 20 only TIMI 0/1 reperfusion was achieved. Thrombolysis-TIMI flow 2/3 and PTCA significantly reduced QTd (from 68 +/- 10 to 35 +/- 8 ms, p < 0.001, deltaQTd = 48 +/- 11%, in the Thr-TIMI flow 2/3 group,and from 79 +/- 11 to 38 +/- 9 ms, p < 0.001, deltaQTd = 52 +/- 9%, in the PTCA group), while in the Thr-TIMI flow 0/1 group no significant changes were recorded. A percent QTd decrease > 30 s had 96% sensitivity, 85% specificity, and 93% positive and 94% negative predictive value, respectively, for TIMI 2/3 flow. CONCLUSIONS: A significant decrease in QT dispersion may provide an additional electrocardiographic index for successful (TIMI 2/3) reperfusion.     

替罗非班在急性心肌梗死溶栓不同时期应用的疗效

目的观察替罗非班在急性心肌梗死溶栓不同时期应用的疗效及安全性。方法：87例sT段抬高型急性心肌梗死患者随机分为常规溶栓组（30例）、早期使用替罗非班组（溶栓前给药28例）和补救替罗非班组（溶栓失败后给药29例）。采用判断溶栓再通间接指标来评估3组患者梗死相关血管的再通率;观察患者出血的发生率及24 h内并发症。结果：早期应用组血管再通率明显提高,心肌肌钙蛋白I浓度峰值、肌酸激酶同工酶浓度峰值和达峰时间与常规溶栓组、补救应用组比较,明显降低和缩短（P〈0．05）,应用替罗非班后较常规溶栓组胸痛持续时间缩短,sT段下降时间提前（P〈0．05）。出血的发生率无统计学意义。在24 h内并发症方面,3组无明显统计学差异。结论：溶栓联合替罗非班,特别是早期应用者可以提高溶栓成功率,减轻心肌损害而不会增加并发症和出血风险。