溶栓危险评分对急性心肌梗塞再灌注治疗患者的预后评价.docVIP

溶栓危险评分对急性心肌梗塞再灌注治疗患者的预后评价 　　作者：王涟，徐标，宋杰，张荣林，张静梅，施广飞 作者单位：南京大学医学院附属鼓楼医院，江苏 南京 210008 　　【摘要】 目的：探讨心肌梗塞溶栓治疗（TIMI）危险评分对接受再灌注治疗的ST段抬高心肌梗塞（STEMI）患者院内死亡的预测价值，能否在入院时筛选出急诊经皮冠状动脉介入（PCI）术获益更大的高危患者。方法：应用TIMI危险评分对267例接受再灌注治疗的STEMI患者进行危险分层，分为低危组（TIMI评分0－4分）及高危组（TIMI评分≥5分），比较两组患者接受急诊PCI与溶栓治疗对院内死亡率的影响。结果：TIMI评分高危组院内死亡率显著高于低危组（14.4%∶2.8%，P=0.001），其中接受急诊PCI治疗的患者死亡率显著低于溶栓治疗的（9.2%∶26.3%，P=0.012）。而低危组患者接受急诊PCI术与溶栓治疗则死亡率无显著差异（2.2%∶3.9%，P=0.618）。结论：TIMI危险评分可作为简便易行的方法评估再灌注治疗STEMI患者的预后，并有助于选择再灌注治疗方案。 　　【关键词】 心肌梗塞；血管成形术，经腔，经皮冠状动脉；血栓溶解疗法 　　基金项目：江苏省科技厅重大项目防治心脑血管疾病规范化诊治集成研究资助（编号：BS2003003）。 　　Predictive value of thrombolysis in myocardial infarction risk score in patients with ST-elevation myocardial infarction received reperfusion therapy 　　WANG Lian，XU Biao，SONG Jie，ZHANG Rong　lin,ZHANG Jing　mei,SHI Guang　fei 　　Chinese Journal of Cardiovascular Rehabilitation Medicine,2007,16(6):526 　　Abstract：Objective:To evaluate the prognostic value of thrombolysis in myocardial infarction (TIMI) risk score in patients with ST-elevation myocardial infarction (STEMI) received reperfusion therapy.Methods:The 267 patients with STEMI were divided into low risk group (TIMI risk score of 0～4 ) or high risk group (TIMI risk score of ≥5) according TIMI risk score，and investigated the effect of primary percutaneous coronary intervention(PCI) versus thrombolysis on mortality in the two groups.Results:In|hospital mortality was significant higher in the high|risk group than that in the low|risk group (14.4%∶2.8%，P=0.001).In high|risk patients there was a significant reduction of mortality in primary PCI group than that in thrombolysis group (9.2%∶26.3%,P=0.012). However in the low|risk group，there was no significant difference in mortality between primary PCI group and thrombolysis group (2.2%∶3.9%,P=0.618).Conclusion:The TIMI risk score can be easily applied for risk stratification at admission in patients with STEMI，and be beneficial in deciding reperfusion strategy. Aut