| 孙丽红,方喜波,李 莉,张英杰,王 玲.半量瑞替普酶溶栓后行转运PCI与直接转运PCI对急性ST段抬高型心肌梗死临床疗效的对比研究[J].,2020,(10):1917-1921 |
| 半量瑞替普酶溶栓后行转运PCI与直接转运PCI对急性ST段抬高型心肌梗死临床疗效的对比研究 |
| A Comparative Study of Clinical Efficacy of Half-dose Reteplase Thrombolytic Transporting PCI and Direct Transporting PCI in the Treatment of Patients with Acute ST-segment Elevation Myocardial Infarction |
| 投稿时间：2019-12-05 修订日期：2019-12-27 |
| DOI：10.13241/j.cnki.pmb.2020.10.027 |
| 中文关键词: 急性ST段抬高型心肌梗死 半量瑞替普酶溶栓 溶栓后转运PCI 直接转运PCI 心肌灌注水平 远期预后 |
| 英文关键词: Acute ST-segment elevation myocardial infarction Half-dose reteplase thrombolysis Transporting PCI after thrombolysis Direct transporting PCI Myocardial perfusion level Long-term prognosis |
| 基金项目:辽宁省自然科学基金项目（1302179） |
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| 中文摘要: |
| 摘要 目的：比较急性ST段抬高型心肌梗死（STEMI）使用半量瑞替普酶溶栓后行转运经皮冠脉介入治疗（PCI）与直接转运两种救治策略的临床效果。方法：回顾性分析2015年6月~2018年2月我院收治的100例STEMI患者的病历资料，根据救治方案不同分为易化PCI组（先在基层医院经半量瑞替普酶溶栓后再转运至我院行PCI，58例）、直接转运PCI组（拒绝在基层医院接受溶栓治疗而要求直接转运PCI，42例）。比较两组PCI前后血管再通率、PCI后无复流发生率和ST段回落率（STR）、住院期间主要不良心脏事件（MACE）及治疗期间出血并发症的发生情况及随访1年主要终点事件的发生情况。结果：入院后首次冠脉造影显示易化PCI组PCI前TIMI 3级血流者占32.7%（19/59），显著高于直接转运PCI组[14.3%（6/42），P<0.05]。PCI后14 d时，易化PCI组TIMI 3级血流者占93.1%（54/58），较直接转运PCI组[90.5%（38/42）]差异无统计学意义（P>0.05）。PCI后即刻冠脉造影显示易化PCI组无复流发生率为6.9%（4/58），较直接转运PCI组[21.4%（9/42）]显著降低（P<0.05）。PCI后24 h时，易化PCI组STR值为（61.53±11.27）%，显著高于直接转运PCI组[（52.40±12.63）%，P<0.05]。住院期间，易化PCI组MACE发生率为10.3%（6/58），较直接转运PCI组[14.3%（6/42）]差异无统计意义（P>0.05）。治疗期间，易化PCI组出血并发症总发生率为19.0%（11/58），与直接转运PCI组的14.3%（6/42）相比差异亦无统计学意义（P>0.05）。随访1年，易化PCI组主要终点事件发生率为19.0%（11/58），显著低于直接转运PCI组[40.5%（17/42），P<0.05]。结论：与直接转运PCI相比，STEMI患者应用半量瑞替普酶溶栓后行转运PCI有利于早期开通梗死血管，提高介入干预效果，PCI后获得优异的心肌灌注水平，从而改善远期预后，且安全性相当。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the clinical efficay of transporting percutaneous coronary intervention (PCI) and direct transporting PCI after thrombolysis with half-dose reteplase in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: The medical records of 100cases of STEMI patients admitted to our hospital from June 2015 to February 2018 were retrospectively analyzed. According to the different treatment schemes, they were divided into facilitated PCI group (58 cases were transported to our hospital after half-dose reteplase thrombolysis) and direct transported PCI group (42 cases refused to receive thrombolysis treatment in primary hospital and required direct transported PCI). The vascular recanalization rate before and after PCI, the rate of no-reflow after PCI, the rate of ST segment fall-back (STR), major adverse cardiac events (MACE) during hospitalization and bleeding complications during treatment were compared between the two groups, and the occurrence of major end-point events during 1 year follow-up were compared. Results: The first coronary angiography after admission showed that 32.7%(19/59) of the patients in facilitated PCI group had TIMI grade 3 blood flow before PCI, which was significantly higher than that in direct PCI group [14.3% (6/42), P<0.05]. At 14 days after PCI, 93.1% (54/58) of TIMI grade 3 blood flow in facilitated PCI group had no significant difference compared with that in direct PCI group [90.5% (38/42)](P>0.05). Immediate coronary angiography after PCI showed that the incidence of no-reflow was 6.9% (4/58) in facilitated PCI group, which was significantly lower than that in direct PCI group [21.4% (9/42)](P<0.05). At 24 hours after PCI, the STR value of facilitated PCI group was (61.53 +11.27)%, which was significantly higher than that of direct transported PCI group [(52.40 +12.63)%, P<0.05]. During hospitalization, the incidence of MACE in facilitated PCI group was 10.3% (6/58). There was no statistical difference between facilitated PCI group and direct PCI group (14.3% (6/42)(P>0.05). During the treatment period, the total incidence of bleeding complications in facilitated PCI group was 19.0% (11/58), and there was no significant difference between facilitated PCI group and direct PCI group (14.3% (6/42) (P>0.05). After 1 year follow-up, the incidence of major endpoint events in facilitated PCI group was 19.0% (11/58), significantly lower than that in direct transshipment PCI group [40.5% (17/42), P<0.05]. Conclusion: Compared with direct transporting PCI, transporting PCI after half-dose reteplase thrombolysis in STEMI patients is beneficial to early opening of infarcted vessels, improving the effect of interventional intervention, obtaining excellent myocardial perfusion level after PCI, thus improving the long-term prognosis of patients, and the safety is comparable. |
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