共查询到20条相似文献,搜索用时 15 毫秒
1.
PAN Xiao-hong ZHONG Wen-zhao XIANG Mei-xiang XU Geng SHAN Jiang WANG Jia-nan 《中华医学杂志(英文版)》2009,122(1):88-92
Background The benefits and safety of sirolimus-eluting stent (SES) have not been systematically quantified in different trials in ST-segment elevation myocardial infarction (STEMI) patients with primary or rescue percutaneous coronary intervention (PCI). A meta-analysis of randomised trials comparing SES and bare-metal stent (BMS) was performed. Methods A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the rate of major adverse cardiac events (MACEs). The secondary outcomes included death, recurrent myocardial infarction, recurrent revascularization, and stent thrombosis.
Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group (9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P 〈 0.00001). No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group (5.1% vs 14.8%, OR 3.30, 95%CI 2.37-4.60, P 〈 0.00001). No significant difference was found between the pooled rates of stent thrombosis (1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%CI 0.79-3.26, P = 0.19).
Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by the greater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to better define the role of SES in STEMI. 相似文献
Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group (9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P 〈 0.00001). No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group (5.1% vs 14.8%, OR 3.30, 95%CI 2.37-4.60, P 〈 0.00001). No significant difference was found between the pooled rates of stent thrombosis (1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%CI 0.79-3.26, P = 0.19).
Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by the greater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to better define the role of SES in STEMI. 相似文献
2.
目的 探讨国产药物支架(DES)对急性ST段抬高型心肌梗死(STEMI)预后的影响.方法 对2004-03~2009-04共216例确诊为STEMI的患者分为两组,药物支架(DES)组(n=117)和裸支架(BMS)组(n=99),术后长期随访,观察术后12个月随访终点时支架内再狭窄发生率(ISR)及主要心血管不良事件(包括死亡、急性心肌梗死、靶血管再成形等)发生率.结果 216例患者经皮冠状动脉介入(PCI)治疗均成功.介入治疗3~12个月后随访结果 显示,DES组再狭窄率明显低于BMS组(P〈0.05),两组心血管不良事件发生率差异无统计学意义(P〉0.05).结论 DES在STEMI患者中有较好的安全性及临床疗效,再狭窄率明显低于BMS(P〈0.05). 相似文献
3.
目的研究ST段抬高性心肌梗死(STEMI)患者体表心电图梗死相关导联ST段抬高总和值与血清超敏C反应蛋白(hs-CRP)水平的关系。方法50例STEMI患者发病后送至急诊室即刻及治疗后6h、12h分别行心电图及血清hs-CRP检查,观察治疗前后hs-CRP水平变化,计算梗死相关导联ST段抬高总和值并与hs-CRP水平进行相关性分析。结果患者入院时梗死相关导联ST段抬高总和值(1.41±0.78)mV与血清hs-CRP水平(16.30±22.77)mg/L呈显著正相关(r=0.732,P<0.01);与治疗前(16.30±22.77)mg/L相比,治疗后6h(2.42±3.63)mg/L与治疗后12h(1.58±0.66)mg/L血清hs-CRP水平均明显下降(P<0.01),且二者间的差异具有统计学意义(P<0.05);ST段抬高总和值≥1.5mV的患者中,各种临床事件发生的概率大大增加(P<0.01)。结论STEMI患者心电图ST段抬高总和值与hs-CRP水平呈显著正相关,治疗后hs-CRP水平下降,具有时间依从性。ST段抬高总和值对STEMI患者的预后评估具有指导意义。 相似文献
4.
目的 探讨住院ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)构成比及院内死亡率逐年变化趋势。方法 回顾性分析2007年1月1日至2018年12月31日于海军军医大学(第二军医大学)长海医院心血管内科住院治疗且出院诊断为急性心肌梗死(AMI)的4 868例患者资料,通过年度变化百分比法(APC)分析STEMI和NSTEMI构成比和院内死亡率的变化趋势。结果 4 868例AMI患者中STEMI 患者3 064例(62.9%),NSTEMI患者1 804例(37.1%)。NSTEMI的比例在12年内呈上升趋势(APC值为14.0%,P<0.01),由2007年的15.7%上升至2018年的45.2%;STEMI患者的比例呈下降趋势(APC值为-5.5%,P<0.01),由2007年的84.3%下降至2018年的54.8%。2007-2018年,AMI院内死亡率呈下降趋势(APC值为-6.6%,P<0.05),由2007年的7.0%下降至2018年的4.3%;NSTEMI院内死亡率呈下降趋势(APC值为-11.9%,P<0.05),由2007年的13.9%下降至2018年的1.9%;而STEMI的院内死亡率并无明显变化(APC值为-3.8%,P=0.225)。结论 2007-2018年我院住院AMI患者中,NSTEMI患者比例呈上升趋势。NSTEMI院内死亡率在12年内呈下降趋势,而STEMI的院内死亡率并无明显下降。 相似文献
5.
目的 探讨雷帕霉素洗脱支架(SES)在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的近、远期疗效及安全性.方法 226例确诊为STEMI患者分为金属裸支架(BMS)组(n=98)和SES组(n=128),分别植入BMS和SES,对比观察术后30 d内及30 d~1年两组主要心脏事件(MACE)[心脏性死亡、非致死性心肌梗死、靶血管再次血运重建率(TVR)]的发生率.结果 术后30 d内两组MACE发生率差异无统计学意义(P>0.05).与BMS组相比,术后30 d~1年SES组MACE发生率显著降低(分别为5.7%和14.9%,P<0.01),主要与TVR显著降低有关(分别为3.3%和11.7%,P<0.01);两组间再次非致死性心肌梗死(分别为0.8%和1.1%)及心脏性死亡(分别为1.6%和2.1%)的发生率差异无统计学意义(均P>0.05).结论 STEMI患者采用SES治疗1年内疗效明显优于BMS,两者安全性相似;长期疗效及安全性还需要进一步临床研究证实. 相似文献
6.
目的:探讨在老年急性心肌梗塞(AMI)急诊经皮冠状动脉介入治疗(PCI)中植入雷帕霉素药物洗脱支架(CypherTM)及普通裸支架对C反应蛋白(CRP)及预后的影响。
方法:45例老年急性AMI患者,分为CypherTM支架组(n=23)和裸支架组(n=22),所有患者在术前、术后6 h、术后1 d、术后7 d、术后1个月测定CRP,临床随访造影及主要心血管事件。
结果:CypherTM支架组23例患者共植入27枚支架,术后TIMI血流3级23例,成功率100%;22例接受随访,随访时间3~11个月,无支架内再狭窄及心血管事件等发生。裸支架组22例患者共植入支架26枚,术后TIMI血流3级21例,临床成功率为95.5%;20例接受随访,随访时间5~13个月,2例患者发生支架内再狭窄(再狭窄率9.09%)。1例猝死,2例新生
血管病变。两组术后6 h、术后1 d CRP水平与术前相比明显增高(P<0.05)。两组之间比较差异无显著性。结论:应用CypherTM支架治疗老年AMI近期安全有效。 相似文献
7.
急性ST段抬高心肌梗死患者发生大出血的危险因素分析 总被引:1,自引:0,他引:1
目的:溶栓、抗凝和抗血小板治疗是急性ST段抬高心肌梗死(STEMI)药物治疗的重要组成部分,但有引起出血的危险.本文旨在从一项大规模临床试验数据库的基线和入院治疗的相关指标中寻找预测出血的危险因素。方法:由该研究入选的15570名发病12h内的STEMI患者的数据库中,筛选大出血的相关因素,应用逐步法多参数Logistic回归,分析发生大出血的独立危险因素。结果:该研究7d内大出血发生率为0.63%。将研究人群分为大出血组和未发生大出血组,发现以下指标两组间存在差异:年龄、性别、地域分布(中国或印度)、梗死部位(前壁或新出现的左束支阻滞)、血糖、随机接受瑞维肝素、溶栓治疗。应用Logistic回归分析从中确定了5个独立的发生大出血的危险因素,按其作用的强弱依次为溶栓治疗、冠脉介入治疗(PCI)、来自印度、随机接受瑞维肝素(与安慰剂对照)、高龄。结论:溶栓治疗、PCI、来自印度、随机接受瑞维肝素、高龄依次为STEMI患者发生大出血的危险因素.该危险因素能为临床医生评估急性心肌梗死患者的出血危险提供参考。 相似文献
8.
目的探讨对应导联ST段压低(reciprocal ST-segment depression,RSTD)在急性ST段抬高心肌梗死(acute ST-elevationmyocardial infarction,STEMI)患者中的临床重要性。方法选取2011年1月至2012年1月共318例STEMI并接受经皮冠状动脉造影(coronary artery angiography,CAG)的患者。根据入院时第1份心电图(electrocardiogram,ECG)是否出现RSTD,将患者分为RSTD组和非RSTD组,评价2组患者基线情况和CAG等结果。结果急性下壁心肌梗死在RSTD组中更常见。RSTD组较非RSTD组患者的收缩压(systolic blood pressure,SBP)和左室射血分数(left ventricular ejection fraction,LVEF)更低、Killip分级更高、肌酸激酶同工酶(creatinekinase-MB,CK-MB)和肌钙蛋白I(troponin I,TnI)的峰值更高、ST段抬高程度更高、合并心房纤颤、传导阻滞和心源性休克的概率更大、多支病变更常见、主动脉内球囊反搏术(intra-aortic balloon pump,IABP)的使用率更高、而且院内病死率更高(P<0.05)。结论伴RSTD的STEMI患者存在不稳定的血流动力学状态,且预后不佳。ECG可以较好地区分高危患者,从而指导治疗方案。 相似文献
9.
目的 探讨体质量指数(BMI)对急性ST段抬高型心肌梗死(STEMI)患者预后的影响.方法 回顾性收集该院2014年收治的STEMI住院患者的临床资料,将患者根据BMI分为4组:低体质量组(n=31)、正常体质量组(n=139)、超重组(n=71)和肥胖组(n=26),对比分析4组患者的临床基线资料,并随访心肌梗死后7d和年内的全因死亡率.结果 BMI越高患者发病年龄越轻(P<0.01),女性所占比例越小(P =0.001),其中肥胖组患者的清蛋白水平、血红蛋白水平均相对较高(P=0.004;P=0.006);心肌梗死后1年的全因死亡率随着BMI升高而明显降低(P=0.003),心肌梗死后7d的全因死亡率差异无统计学意义(P=0.287).结论 BMI与STEMI患者的远期预后相关,“肥胖矛盾”现象在STEMI患者中是存在的,但应结合患者年龄、性别、并发症和药物治疗等多个因素综合评估BMI对STEMI患者预后的影响. 相似文献
10.
目的:探讨血清丙氨酸转氨酶(ALT)与急性ST段抬高型心肌梗死(STEMI)的临床意义,进一步研究ALT是否为STEMI患者的预测因素.方法:选择心脏科住院患者909例,分为对照组患者(无冠心病患者)355例,急性STEMI患者554例,其亚组分型包括:(1)依据血管病变程度分组(单支组154例,双支组176例,多支组224例);(2)依据心肌梗死发病到空腹抽血时间分组(0~24 h组296例,24~48 h组124例,超过48 h组134例).统计所有入选患者的基本临床资料、生化资料及冠脉造影资料,回顾性分析ALT与急性心肌梗死的相关性.结果:急性STEMI组与对照组在年龄、尿素氮、肌酐、天冬氨酸转氨酶、ALT、高密度脂蛋白等有明显统计学差异(P<0.01);在急性STEMI患者亚组分析中,ALT与急性STEMI患者血管病变的严重程度有统计学意义(P<0.05),且患者ALT在空腹抽血时间(从心梗发病计算)上有明显的统计学差异(P<0.01);Logistic回归分析结果示ALT(OR=0.911)、年龄(OR=1.068)、肌酐(OR=1.041)、天冬氨酸转氨酶(OR=1.270)是急性STEMI的危险预测因素.结论:ALT与急性STEMI密切相关,ALT是急性STEMI患者新的预测因素. 相似文献
11.
目的本研究通过比较糖尿病患者置入金属裸支架(bare metal stents,BMS)vs药物洗脱支架(drug eluting stents,DES)后发生死亡、心肌梗死(myocardial infarction,MI)、再次血运重建和支架血栓的情况,以评价糖尿病患者置入DES后的远期安全性和有效性。方法本研究于2003年7月~2005年12月连续入选了834例因冠心病合并糖尿病在首都医科大学附属北京安贞医院心内科行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,按置入支架类型将患者分为DES组(n=583)和BMS组(n=251)。主要终点事件为24个月时全因病死率;次要终点事件为24个月时非致死性MI、再次血运重建以及主要不良心血管事件(major adverse cardiac events,MACE)的发生率。结果本研究结果经多因素回归分析显示,DES组明显降低了24个月时死亡[3.2%vs 5.1%,危险比(hazard ratio,HR)0.34,95%可信区间(confidential interval,CI)0.12~0.94,P=0.038]和心性死亡的风险(2.2%vs 4.4%,HR=0.29,95%CI:0.13~0.87,P=0.027),非致死性MI和心性死亡与非致死性MI复合终点发生风险比较差异无统计学意义;明确和可能的支架血栓的发生风险比较差异也没有统计学意义(1.9%vs 2.0%,HR=0.96,95%CI:0.51~2.17,P=0.351)。DES明显降低了再次血运重建的风险(10.5%vs 20.7%,HR=0.24,95%CI:0.11~0.78,P<0.001)和靶血管再次血运重建的风险(8.9%vs 17.1%,HR=0.33,95%CI:0.16~0.87,P<0.001);与BMS组比较DES组的MACE的风险也明显降低,差异有统计学意义(15.8%vs 27.9%,HR=0.19,95%CI:0.09~0.85,P<0.001);其主要与DES组患者的死亡和靶血管再次血运重建的风险降低有关。结论与BMS相比,DES可显著降低糖尿病患者的24个月时死亡、再次血运重建和MACE的风险,而未增加非致死性MI和支架血栓的风险。置入DES后死亡风险的降低原因,主要与DES降低再狭窄后的死亡和MI风险,获得更高的完全血运重建率以及未增加支架血栓的风险相关。 相似文献
12.
Wang CH Fang Q Zhang SY Shen ZJ Fan ZJ Jin XF Zeng Y Liu ZY Xie HZ Yang M 《中华医学杂志(英文版)》2012,125(16):2803-2806
Background The long-term safety and efficacy of drug-eluting stents (DES) versus bare metal stents (BMS) are unclear and controversial issues in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation.
Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES (n=83) or BMS (n=108) implantation in the infarction related artery according to physician’s discretion. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis. The difference of MACE was observed between DES and BMS groups.
Results The clinical follow-up duration was 3 years ((41.7±16.1) months). MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction (LVEF) was an independent predictor for MACE in the follow-up period (P=0.0301). There was no significant difference in all-cause mortality (3.61% vs. 7.41%, P=0.2647), the incidence of myocardial infarction (0 vs. 0.93%, P=0.379) and stent thrombosis (1.20% vs. 1.85%, P=0.727) between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group (4.82% vs. 14.81%, P=0.0253). The rate of TVR was also lower in the DES group (0 vs. 5.56%, P=0.029). In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents (SES, n=73) and paclitaxel-eluting stents (PES, n=10) subgroups (2.74% vs. 20.00%, P >0.05).
Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up. 相似文献
13.
ZHANG Qi ZHANG Rui-yan QIU Jian-ping JIN Hui-gen ZHANG Jun-feng WANG Xiao-long JIANG Li LIAO Min-lei HU Jian DING Feng-hua ZHANG Jian-sheng SHEN Wei-feng 《中华医学杂志(英文版)》2009,122(6):636-642
Background Current guidelines support primary percutaneous coronary intervention (primary PCI) as the first treatment of choice (as opposed to thrombolytic therapy) for patients with acute ST-segment elevation myocardial infarction (STEMI) especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI. Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory (rapid group), and 275 patients were admitted to the coronary care unit (CCU) or cardiac ward first, and then transferred to the catheterization laboratory (non-rapid group). Primary endpoint was door-to-balloon (D2B) time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events (MACE) including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.
Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein lib/Ilia receptor inhibitors before angiography (84.0% and 77.1, P=0.042) and had TIMI 3 flow in the culprit vessel at initial angiogram (17.1% and 9.2%, P=0.007) in the non-rapid group. The D2B time was shortened ((108±44) minutes and (138±31) minutes, P 〈0.0001), and number of patients with D2B time 〈90 minutes was greater (22.6% and 10.9%, P 〈0.0001) in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality (4.1% and 5.8%) and cumulative MACE rate (7.0% and 9.8%) did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group (94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively).
Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours. 相似文献
Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein lib/Ilia receptor inhibitors before angiography (84.0% and 77.1, P=0.042) and had TIMI 3 flow in the culprit vessel at initial angiogram (17.1% and 9.2%, P=0.007) in the non-rapid group. The D2B time was shortened ((108±44) minutes and (138±31) minutes, P 〈0.0001), and number of patients with D2B time 〈90 minutes was greater (22.6% and 10.9%, P 〈0.0001) in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality (4.1% and 5.8%) and cumulative MACE rate (7.0% and 9.8%) did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group (94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively).
Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours. 相似文献
14.
盐酸替罗非班在急性ST段抬高型心肌梗死介入治疗中的有效性及安全性探讨 总被引:1,自引:0,他引:1
目的:观察血小板糖蛋白GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术(PCI)后的心肌灌注及安全性的影响。方法:选择急诊入院ST段抬高型心肌梗死患者62名,随机分为治疗组(盐酸替罗非班+PCI)31例和对照组(PCI)31例。收集所有病例的临床和冠状动脉造影资料,观察PCI术后冠状动脉血流、出血并发症及住院期间不良心脏事件发生率(MACE)情况。结果:治疗组患者PCI术后TIMI 3级血流比例高于对照组(P〈0.05;100%vs 80.6%)。治疗组PCI术后ST段完全回落组(≥70%)的比例为38.7%,高于对照组的12.9%,差异具有统计学意义(P〈0.05)。两组患者在出血并发症及住院期间不良心脏事件发生率上的差异均无统计学意义(P〉0.05)。结论:盐酸替罗非班可改善急性STEMI患者梗死相关血管的血流灌注,且不增加出血并发症及住院期间不良心脏事件的发生。 相似文献
15.
目的:观察急性ST段抬高型心肌梗死(STEMI)梗死相关动脉(IRA)自发再通(SR)患者的凝血功能指标,对其是否与SR相关进行分析。方法:连续入选STEMI且符合入选条件者共153例,根据急诊冠状动脉造影术中IRA血流分级,将其分为SR组51例,未自发再通(NSR)组102例。于患者入院时抽取静脉血,检测血小板功能参数、凝血常规、D-二聚体、肝肾功能等指标,分析两组患者的一般临床资料、检验指标、冠脉造影等资料特点。结果:两组在冠心病危险因素、肝肾功能、血小板功能参数、D-二聚体等方面差异无统计学意义(P〈0.05)。SR组梗死前心绞痛检出率显著高于NSR组(45.10% vs 526.47%,P〈0.05),部分凝血活酶时间(P1阿)高于NSR组[(24.26±3.55)s vs(22.93±3.49)s;P〈0.051。Pearson相关分析结果提示,梗死前心绞痛、PTT与IRA的SR有较强相关。结论:梗死前心绞痛、PTT水平的延长可以作为冠脉自发再通的预测指标。 相似文献
16.
急性非ST段抬高型与ST段抬高型心肌梗死冠脉病变特征比较 总被引:1,自引:0,他引:1
目的比较非ST段抬高型急性心肌梗死(NSTEAMI)与ST段抬高型急性心肌梗死(STEAMI)冠状动脉病变的特点。方法回顾NSTEAMI与STEAMI患者的临床及冠状动脉造影资料,分析二者的临床特点及冠状动脉病变血管的支数、狭窄程度及侧支循环情况。结果 NSTEAMI组的多支病变率为63.34%,其中大于75%的严重狭窄率为78.33%,侧支循环率为30.00%,三者均高于STEAMI组,而完全闭塞率为8.33%,低于STEAMI组。两组间高血压、糖尿病患病率差异无统计学意义。在病变血管的构成上组间无差异。结论 NSTEAMI的冠状动脉病变程度高于STEAMI,完全闭塞率低于后者,二者具有不同的冠状动脉病变特点。 相似文献
17.
目的:观察ST段抬高型急性心肌梗死溶栓治疗的临床效果。方法:选择36例具备溶栓适应证的ST段抬高型急性心肌梗死患者,在一般常规治疗基础上,给予尿激酶150万U,配合肝素静脉滴注,溶栓治疗开始后90分钟监测心电图ST段抬高程度、临床症状演变、心肌酶学峰值和心律的变化,并评估疗效。结果:在一般常规治疗基础上配合尿激酶规范化溶栓治疗,ST段抬高至少降低50%,胸痛症状明显缓解,心肌酶学峰值前移,并出现再灌注心律失常。结论:在具备溶栓适应证前提下,给予尿激酶规范化溶栓治疗ST段抬高型急性心肌梗死,可提高血管再通率,是降低患者死亡率和改善预后的重要方法。 相似文献
18.
目的评价磺达肝癸钠对急性ST段抬高心肌梗死(ST-segment e1evation myocardia1 infarction,STEMI)患者接受直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的疗效和安全性。方法 STEMI并且接受直接PCI患者160例,随机分成观察组(82例)和对照组(78例)。观察组使用磺达肝癸钠+类普通肝素(unfractionated heparin,UFH)安慰剂,对照组使用UFH+类磺达肝癸钠安慰剂,采用随机双盲平行对照法。主要观测指标为第9天的死亡或再梗死率及出血事件,以及随访第3天、第30天、1年和3年时二次评估。结果磺达肝癸钠组第9天出血事件4.9%(4/82),显著低于对照组出血事件14.1%(11/78),P〈0.05,两者有统计学差异;同样结果见于随访的第30天。磺达肝癸钠组第9天死亡或再梗死率8.5%(7/82),对照组7.7%(6/78),P〉0.05,两者无统计学差异;同样结果见于第3天、第30天、1年和3年。磺达肝癸钠组中2例患者PCI术期间发现导管内血栓,且直接PCI术前均未接UFH。结论与UFH相比,磺达肝癸钠在STEMI接受直接PCI治疗的人群中,明显减少出血事件,且未增加死亡和再梗死率。单用磺达肝癸钠有发生导管内血栓事件的趋向,可考虑联合应用UFM。 相似文献
19.
目的探讨急性ST段抬高型心肌梗死(STEMI)患者在经皮冠状动脉介入治疗(PCI)术后应用羟苯磺酸钙的疗效。方法选取2013年10月至2016年10月急诊PCI治疗的164例STEMI患者,分为两组,对照组给予指南规定用药,研究组在对照组用药基础上术后当日予以羟苯磺酸钙500mg/次,3次/d,连续应用3个月。对比两组患者术后72h内肌酸激酶同工酶(CK-MB)、血清肌钙蛋白I(cTNI)峰值及其释放的峰值曲线下面积;术前及术后3个月心超检查结果;术后3个月6min步行试验(6MWT)结果;术前及术后多个时间点检测血清N端B型利尿肽前体(NT-proBNP)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、一氧化氮(NO)含量;检测血液流变学相关指标,包括全血黏度、血浆黏度、红细胞聚集指数(EDI)和血小板聚集率等。结果术后两组CK-MB、cTNI峰值及其释放的峰值曲线下面积无差别。术后3个月研究组左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室射血分数(LVEF)、室壁运动计分指数(WMSI)、6MWT均显著优于对照组。研究组NT-proBNP、hs-CRP、ET-1显著低于对照组,而NO含量高于对照组;研究组血液流变学相关指标明显改善。结论STEMI患者在PCI术后应用羟苯磺酸钙虽短时间内并不能减少心肌梗死面积,但3个月后能改善心功能。这可能与羟苯磺酸钙通过改善冠状动脉内皮功能和血液流变学性能,进而改善冠状动脉微循环、抑制STEMI区域的局部炎症反应有关。该药可作为心肌梗死再灌注治疗后的辅助用药应用于临床。 相似文献
20.
目的 分析ST段抬高性心肌梗死(STEMI)合并心力衰竭患者的预后及其影响因素.方法 选取2010年1月至2014年6月收治的STEMI合并心力衰竭患者共163例,根据其是否在院期间死亡分为存活组和死亡组.对比两组患者一般情况、血液生化指标和心电图等临床资料.同时对比存活组患者溶栓前后的血清hs-CRP、CK-MB、TNT和BNP水平.采用多变量logistic回归分析患者住院期间病死率的预测因素.结果 死亡组的男性、年龄>65岁、前壁心肌梗死(MI)、高血压、高血脂、饮酒、糖尿病、Killip分级≥II级比率显著高于存活组,差异有统计学意义(P<0.05);死亡组的白细胞、血肌酐、肌酸激酶同功酶(CK-MB)、三硝基甲苯(TNT)、超敏C反应蛋白(hs-CRP)、甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脑尿钠肽(BNP)均显著高于存活组,而HDL-C显著低于存活组(P<0.01);存活组患者溶栓后血清hs-CRP、CK-MB、TNT和BNP显著低于溶栓前,(P<0.05).死亡组的溶栓成功率显著低于存活组,且差异有统计学意义(P<0.01).结论 高龄、血肌酐和hs-CRP水平升高、前壁MI、BNP升高、LDL-C水平升高、HDL-C水平降低、溶栓不通、在院期间发生心源性休克和Killip分级≥Ⅱ级因素影响急性心肌梗死合并心力衰竭患者的预后. 相似文献