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目的探讨延迟PCI治疗急性心肌梗死对改善左室重构和缩小心肌梗死面积的效果.方法312例ST段抬高性急性心肌梗死患者,分为直接PCI治疗组65例,延迟PCI治疗组81例,尿激酶静脉溶栓治疗组74例,药物保守治疗组92例.全部患者随访6~36个月,观察住院期间和随访期间的主要心脏事件、复合终点事件和超声心动图变化及利用QRS计分评估梗死范围的变化.结果1)延迟PCI组平均住院时间为(14.1±11.7)d,显著少于静脉溶栓(20.5±8.4)d和内科药物治疗组(19.2±9.4)d(P<0.05);而与直接PCI组的住院时间相同(P>0.05).2)延迟PCI的复合终点事件发生率显著少于静脉溶栓和内科药物治疗组(P<0.05);与直接PCI组比较,无显著差异(P>0.05).3)本组随访6~36个月,平均随访(21.5±4.6)个月时.随访期间,延迟PCI组的心力衰竭及复合终点事件的发生率显著低于静脉溶栓组和内科药物治疗组(P<0.05).4)超声心动图随访结果显示,在住院期间和随访期间,延迟PCI组的LVEF显著高于非PCI治疗组(P<0.05),而延迟PCI组的LAD和LVDd均显著小于非PCI延迟组.5)延迟PCI组的心肌梗死范围回缩率(0.376±0.138)显著大于内科药物治疗组(0.173±0.094)(P<0.05),而与直接PCI组(0.413±0.169)和溶栓组(0.289±0.177)相似.结论延迟PCI治疗急性心肌梗死可改善患者的左室重构,缩短平均住院时间,减少住院期间和随访期间的心脏事件、复合终点事件发生率,使心肌梗死面积缩小.
Objective To investigate the effect of delayed PCI on acute left ventricular remodeling and myocardial infarct size reduction.Methods Thirty-two ST-segment elevation acute myocardial infarction patients were divided into direct PCI group (n = 65) and delayed PCI group (n = 81) , 74 cases of urokinase intravenous thrombolysis group and 92 cases of drug conservative treatment group.All the patients were followed up for 6 to 36 months.The main cardiac events during hospitalization and follow-up, composite end-point events and echocardiographic changes, (1) The average length of hospital stay in the delayed PCI group was (14.1 ± 11.7) days, significantly less than that in the intravenous thrombolysis group (20.5 ± 8.4 days) and the medical therapy group (19.2 ± 9.4 days) (P < 0.05), while the hospitalization time was the same as that of the direct PCI group (P> 0.05) .2) The incidence of the composite end point of delayed PCI was significantly less than that of intravenous thrombolysis and medical therapy group (P <0.05) (P> 0.05) .3) This group was followed up for 6 to 36 months with an average follow-up of (21.5 ± 4.6) months.The incidence of heart failure and composite end point events in the delayed PCI group was significantly lower at follow-up Intravenous thrombolysis group and medical treatment group (P <0.05) .4) Echocardiographic follow-up results showed that, During hospitalization and follow-up, the LVEF in delayed PCI group was significantly higher than that in non-PCI group (P <0.05), while LAD and LVDd in delayed PCI group were significantly lower than those in non-PCI delayed group.5) (0.376 ± 0.138) was significantly higher than that of the medical treatment group (0.173 ± 0.094) (P <0.05), but similar to the direct PCI group (0.413 ± 0.169) and the thrombolytic group (0.289 ± 0.177) Conclusion The delayed PCI Acute myocardial infarction can improve left ventricular remodeling, shorten the average length of stay, reduce cardiac events during hospitalization and follow-up, the incidence of composite end point, myocardial infarction size.