延迟急诊PCI治疗急性ST段抬高型心肌梗死及患者预后探究.docVIP

延迟急诊PCI治疗急性ST段抬高型心肌梗死及患者预后探究 　　【摘要】 目的 探?延迟急诊经皮冠状动脉介入治疗（PCI）急性ST段抬高型心肌梗死（STEMI）的疗效及预后情况。方法 100例急性STEMI患者， 按照PCI时机将其分为延迟组（45例）和溶栓组（55例）。延迟组患者发病12～24 h内被确诊， 并立即行PCI治疗；溶栓组患者发病6 h内被确诊， 并行溶栓药物治疗， 择期行PCI治疗。对两组患者PCI治疗前后梗死相关动脉（IRA）情况[以心肌梗死溶栓试验（TIMI）分级评价]和并发症发生情况进行比较。结果 PCI治疗前IRA情况比较， 延迟组TIMI 0～1级所占比例100.0%明显高于溶栓组61.8%， 差异有统计学意义（P0.05）。延迟组严重心力衰竭、恶性心律失常发生率26.7%、28.9%高于溶栓组9.1%、9.1%， 差异均有统计学意义（P0.05）。结论 延迟急诊PCI应用于急性STEMI的治疗中有助于及时疏通IRA， 梗死后心绞痛发生率与早期溶栓成功再行PCI相当， 不过术后严重心力衰竭、恶性心律失常的发生率较高 【关键词】 延迟急诊经皮冠状动脉介入治疗；急性ST段抬高型心肌梗死；梗死相关动脉；并发症 DOI：10.14163/j.cnki.11-5547/r.2017.12.023 【Abstract】 Objective To explore the curative effect of delay emergency percutaneous coronary intervention （PCI） in the treatment of acute ST segment elevation myocardial infarction （STEMI） and its prognosis. Methods A total of 100 acute STEMI patients were divided by PCI timing into delay group （45 cases） and thrombolysis group （55 cases）. The delay group had patients confirmed within 12～24 h and they received PCI therapy immediately. The thrombolysis group had patients confirmed within 6 h， and they received thrombolytic drugs and selective PCI therapy. Comparison were made on infarction related artery （IRA） condition [evaluated by thrombolysis in myocardial infarction （TIMI）] and occurrence of complications before and after PCI in two groups. Results Comparison in IRA condition before PCI， the delay group had obviously higher TIMI proportion of grade 0～1 as 100.0% than 61.8% in thrombolysis group， and the difference had statistical significance （P0.05）. The delay group had higher incidence of severe heart failure and malignant arrhythmia as 26.7% and 28.9% than 9.1% and 9.1% in thrombolysis group （P0.05）. Conclusion Application of delay emergency PCI in acute STEMI treatment helps timely dredge IRA， and the incidence of angina pectoris after infarction is equel to early successful thrombolysis and PCI. While it has high incidence of severe heart failure and malignant arrhythmia. 【Key words】 Delay eme