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目的 :比较rt PA(5 0mg)静脉溶栓后即刻行经皮腔内冠状动脉成形术 (PTCA)与直接冠状动脉支架术治疗急性心肌梗死 (AMI)的临床疗效。方法 14 0例AMI患者 ,随机分为A、B两组。A组 75例行rt PA半量 (5 0mg)静脉溶栓后即刻行冠状动脉造影 (CAG)、PTCA及冠状动脉支架术。B组 6 5例直接行CAG、PTCA及冠状动脉支架术。术后观察 2 0d。结果 :①首次冠状动脉造影显示 :A组梗死相关动脉 (IRA) 83支 ,开通率 5 2 % ;B组IRA 71支 ,开通率 15 %。两组开通率相比差异有非常显著性意义 (P <0 .0 1)。②A、B两组行PTCA加支架置入术后IRA恢复TIMIⅢ级血流效果基本相同 ,A组 10 0 % ,B组 98.6 % ,两者相比差异无显著性意义 (P >0 .0 5 )。③患者住院 10～ 2 0d ,二维超声心动图显示 ,左室射血分数达到或超过 6 0 %者 ,A组为 94 .7% ,而B组仅占 4 3.9%。两者相比差异有显著性意义 (P <0 .0 5 )。④脑卒中或大出血并发症两组病例均未发生。⑤住院病死率 ,A组 4 .0 % (3/ 75 ) ,B组 3.1% (2 / 6 5 ) ,两者相比差异无显著性意义 (P >0 .0 5 )。结论 :A组较B组具有更早地使IRA前向血流再灌注 ,从而具有较好的左室保护功能 ,且不增加不良事件的发生。
Objective: To compare the clinical efficacy of percutaneous transluminal coronary angioplasty (PTCA) and direct coronary stenting in the treatment of acute myocardial infarction (AMI) after rtPA (50 mg) intravenous thrombolysis. Methods Forty AMI patients were randomly divided into A and B groups. In group A, 75 patients underwent coronary angiography (CAG), PTCA and coronary stenting immediately after intravenous thrombolysis with rt PA 50 mg. Sixty-five patients in group B received CAG, PTCA and coronary stenting directly. Postoperative observation 20d. Results ① The first coronary angiography showed that there were 83 infarction-related arteries (IRA) in group A, with an opening rate of 52%. Group B had IRA of 71 and opening rate was 15%. There was a significant difference between the two groups (P <0 01). ②After PTCA plus stent implantation, there was no significant difference between the two groups in the recovery of TIMI grade III IRA (100% in group A and 98.6% in group B) (P> 0.05) ). ③ The patients were hospitalized 10 ~ 20d, two-dimensional echocardiography showed left ventricular ejection fraction reached or exceeded 60% in group A 94.7%, while group B accounted for only 4 3.9%. There was significant difference between the two groups (P <0.05). ④ stroke or bleeding complications in both groups did not occur. (5) In-hospital mortality was 4.0% (3/75) in group A and 3.1% (2/65) in group B, with no significant difference between the two groups (P> 0.05). CONCLUSION: Compared with group B, group A reperfusion forward IRA earlier, which has better left ventricular function and does not increase the incidence of adverse events.