介入与溶栓治疗应用于ST段抬高急性心肌梗死的临床评价

目的 :探讨ST段抬高急性心肌梗死 (STEMI)患者选择介入与溶栓治疗的临床疗效与安全性 ,并对二者进行比较。方法 :采取国内外文献综述方法。结果 :几十年来 ,溶栓是急性心肌梗死再灌注治疗的主要手段 ,但由于溶栓治疗的局限性 ,直接PCI已逐渐成为首选的再灌注治疗。直接PCI可使TIMI 3级血流率达 90 %以上 ,较溶栓降低死亡、再梗死、脑出血、缺血复发、梗死血管再闭塞。然而当行PCI治疗需延迟几小时时 ,溶栓治疗可在发病后即刻给予 ,促进梗死血管早期再灌注。结论 :希望建立一个完整的医疗体系而使最有效的治疗相对迅速地用于每个STEMI患者 ,而预防仍然是最重要的

Evaluation of PCI or Thrombolytic Therapy for Patients with Acute ST-segment Elevation Myocardial Infarction

OBJECTIVE:To study clinical efficiency and safety of the choice of PCI and thrombolytic therapy for patients with acute STEMI,and mak e a comparison between them.METHODS:By reviewing the literatures at home and abr oad.RESULTS:Thrombolytic therapy has been an important means of establishing rep erfusion in patients with acute ST-segment elevation myocardial infarction for d ecades.However,there are many limitations to the use of thrombolytic therapy,so primary percutaneous coronary intervention(PCI)has emerged as the preferred repe rfusion strategy.Primary PCI is superior to throm bolysis in reducing death, rein faretion,intracranial bleeding,recurrent ischemia,and reoeclusion of infaret ves sel.When PCI needs to be delayed several hours, thrombolytic therapy may be give n immediately after onset of the ST-segment elevation infaretion,and facilitate early reperfusion of infarct vessel.CONCLUSION:It is hopeful that a complete med ical care system that makes the best therapy available relatively prompt for ind ividuals who experience ST-segment elevation infarct,but prevention remains most important.