论文部分内容阅读
目的观察ST段抬高急性心肌梗死(STEMI)患者再灌注治疗策略对STEMI患者预后的影响。方法选取2012年2月至2012年12月到河南科技大学第一附属医院就诊的STEMI患者238例,根据目前PCI诊疗指南和患者的意愿,分为PCI组、单纯溶栓治疗组或药物治疗组,了解本地区STEMI的诊疗现状,比较不同再灌注策略对STEMI患者预后的影响。结果 (1)所有入选患者,随访6个月PCI组死亡9例(4.3%),单纯溶栓组死亡2例(14.3%),药物治疗组死亡2例(14.3%);在行溶栓治疗的35例患者中,溶栓+PCI组21例中死亡1例(4.8%),与单纯溶栓组14例中死亡2例(14.3%)比较,两组间差异有统计学意义(P<0.05);D2B时间中位数110 min。(2)BMS组支架内晚期血栓形成的发生高于DES组,差异有统计学意义(2.8%比0,P<0.05),但两组主要不良事件发生率差异无统计学意义(7.5%比6.9%,P>0.05)。(3)PCI组脑卒中发生率显著高于单纯溶栓组和药物治疗组(1.0%比0,P<0.05;1.0%比0,P<0.05);(4)PCI组出血发生率显著高于单纯溶栓组和药物治疗组(1.0%比0,P<0.05;1.0%比0,P<0.05)。结论多数STEMI患者选择PCI;但D2B时间较长,D2B<90 min比例较低;与单纯溶栓和药物保守治疗相比,PCI更能改善STEMI患者的预后。
Objective To investigate the effect of reperfusion therapy on the prognosis of STEMI patients with ST-segment elevation acute myocardial infarction (STEMI). Methods A total of 238 STEMI patients who visited the First Affiliated Hospital of Henan University of Science and Technology from February 2012 to December 2012 were divided into PCI group, simple thrombolytic therapy group or drug treatment group according to the current PCI guidelines and patients’ wishes. To understand the status of diagnosis and treatment of STEMI in this area and compare the effects of different reperfusion strategies on the prognosis of patients with STEMI. Results (1) All patients were enrolled in this study. Nine patients (4.3%) died of PCI in the PCI group, 2 patients died in the thrombolytic group (14.3%) and 2 patients died in the drug treatment group (14.3% Among the 35 patients, 1 died in 21 cases (4.8%) in the thrombolysis + PCI group and 2 cases died in 14 cases (14.3%) in the simple thrombolysis group, with significant difference between the two groups (P < 0.05). The median time of D2B was 110 min. (2) The incidence of advanced thrombosis in BMS group was significantly higher than that in DES group (2.8% vs 0, P <0.05), but there was no significant difference in the incidence of major adverse events between the two groups (7.5% vs 6.9%, P> 0.05). (3) The incidence of stroke in PCI group was significantly higher than that in thrombolytic group and drug treatment group (1.0% vs 0, P <0.05; 1.0% vs 0, P <0.05); (4) The incidence of bleeding in PCI group was significantly higher In simple thrombolysis group and drug treatment group (1.0% vs 0, P <0.05; 1.0% vs 0, P <0.05). Conclusions Most patients with STEMI choose PCI. However, D2B is longer and the ratio of D2B is less than 90 minutes. Compared with simple thrombolysis and conservative treatment, PCI can improve the prognosis of STEMI patients.