急性心肌梗死再灌注治疗的远期效果评价

目的通过长期观察急性心肌梗死（AMI）后接受急诊经皮冠状动脉介入术（PCI）、单纯静脉溶栓、静脉溶栓＋延迟PCI以及未再灌注治疗患者，了解其心功能变化及严重心脏事件的发生情况，以对AMI治疗的几种方法作出评价，更好地指导基层医院治疗。方法选择ST段抬高心肌梗死（STEMI）患者137例，分为再灌注治疗组108例（包括急诊PCI组29例，静脉溶栓组43例，静脉溶栓＋延迟PCI组36例）和未再灌注治疗组29例，连续观察3个月至3年，对其心功能变化及严重心脏事件发生情况进行统计比较和分析。结果再灌注治疗组远期严重的心血管事件发生率明显低于未接受再灌注治疗组（P〈0．05）；LVEF≥50％者高于未再灌注组（P〈0．05）；动态心电图心律失常发生率无显著差异。其中以急诊PCI组与3h内溶栓远期效果最佳。结论AMI后行再灌注治疗与未行再灌注治疗远期疗效有显著差别。其中3h内溶栓与急诊PCI组，溶栓失败后行补救性PCI与3h内溶栓及急诊PCI均无明显差异。

Evaluate effectiveness of long - term for acute myocardial infarction with reperfusion therapyh

Objective Through long - term observation of patients who has been treated by percutaneous coronary intervention（PCI） ,vein fibrinolytic,vein fibrinolytic combined with delayed PCI,as well as no -reperfusion,we can find out the occurrence of their cardiac function and serious cardiac events,in order to evaluate the ways of AMI treatment and guide the grass - roots hospital better. Methods We selected 137 patients in our hospital who have ST - elevation myocardial infarction （STEMI）. According to whether treated by reperfusion or not, we divide 108 cases into reperfusion group （including 29 cases of Emergency PCI group ,43 cases of venous fibrinolytic group ,36 cases of venous fibrinolytie and delayed PCI group, and 29 eases into no - reperfusion group. Through continuous observation from 3 months to 3 years, we compared and analyzed their cardiac function and serious cardiac events statistically. Results 102 cases were to observe at random （ the rate of which is 74. 4% ）. According to the records of their symptoms, signs, biochemical parameters, arrhythmia circumstances, UCG, as well as changes in drug use, we use the cardiac function NYHA classification, evaluation of the quality of life table, 6 - minute walking distance,LVFF and DCG examination to evaluate the patients＇s cardiac function and serious cardiac events. The reperfusion therapy group in long - term treatment of serious cardiovascular events are significantly lower than no - reperfusion therapy group（P 〈0. 05） ,the group with LVEF≥50% are higher than the group of no - reperfusion（P 〈0. 05） ; The incidence rate of DCG arrhythmia is no significant difference. The emergency PCI group and fibrinolytic with long - term effect in 3 hours are best. Conclusion Taking reperfusion treatment after AMI and no - reperfusion treatment in long - term effect have significant difference. Fibrinolytic in 3 hours and emergency PCI group, remedy for PCI after the failure of fibrinolytic, fibrinolytic in 3 hours and emergency PCI all have no significant difference.