替普酶溶栓后早期行PCI治疗STEMI的有效性研究
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摘要
目的探讨瑞替普酶溶栓后早期行经皮冠状动脉介入术治疗ST段抬高型心肌梗死患者的临床价值。方法方便选取该院于2016年2月—2017年8月期间所收治的ST段抬高型心肌梗死患者54例纳入该次研究中,根据当时患者入院情况将其分为研究组和对照组,每组各为27例。研究组行易化PCI手术治疗,对照组行直接PCI术治疗,对比两组冠状动脉造影和介入手术后TIMI分级情况、术前、术后心功能对比以及随访情况。结果①研究组冠状动脉造影时的TIMI血流2-3级明显高于对照组,组间对比有统计学意义(P<0.05),但介入干预后两组最终TIMI血流2、3级患者对比差异无统计学意义(P>0.05);②术前研究组心功能(55.47±18.55)分和对照组(53.03±6.66)分差异无统计学意义(t=0.643 2 P>0.05),术后研究组(61.31±8.16)分和对照组(59.99±6.57)分对比差异无统计学意义(t=0.654 7 P>0.05);③研究组27例中出现心脏不良反应共6例,对照组出现8例不良反应,组间对比差异无统计学意义(χ~2=0.3857 P>0.05)。结论易化PCI手术的应用对ST段抬高型心肌梗死的治疗更加有利。
Objective To investigate the clinical value of early percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction after thrombolytic therapy with reteplase. Methods A total of 54 patients with ST-segment elevation myocardial infarction who were admitted to our hospital from February 2016 to August 2017 were convenient selected and included in the study. According to the admission of the patients at the time, they were divided into study group and control group, 27 cases each. The study group underwent PCI and the control group underwent direct PCI. The TIMI grading, preoperative and postoperative cardiac function comparison and follow-up were compared between the two groups. Results 1.The TIMI blood flow of the study group was significantly higher than that of the control group at 2-3 grades. The comparison between the two groups was statistically significant(P<0.05), but the final TIMI blood flow of patients with grade 2 and 3 after interventional intervention. There was no difference in contrast(P>0.05). 2.There was no statistically significant difference between the preoperative group(55.47±18.55)points and the control group(53.03±6.66)points(t=0.643 2, P>0.05). There was no significant difference between the scores of(61.31 ±8.16)points and the control group(59.99±6.57)points(t=0.654 7, P>0.05). 3.There were 6 cases of adverse cardiac reactions in 27 cases in the study group and 8 cases of adverse reactions in the control group. There was no statistically significant difference between the groups(χ~2=0.385 7, P>0.05). Conclusion The application of facilitating PCI is more beneficial for the treatment of ST-segment elevation myocardial infarction.
Objective To investigate the clinical value of early percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction after thrombolytic therapy with reteplase. Methods A total of 54 patients with ST-segment elevation myocardial infarction who were admitted to our hospital from February 2016 to August 2017 were convenient selected and included in the study. According to the admission of the patients at the time, they were divided into study group and control group, 27 cases each. The study group underwent PCI and the control group underwent direct PCI. The TIMI grading, preoperative and postoperative cardiac function comparison and follow-up were compared between the two groups. Results 1.The TIMI blood flow of the study group was significantly higher than that of the control group at 2-3 grades. The comparison between the two groups was statistically significant(P<0.05), but the final TIMI blood flow of patients with grade 2 and 3 after interventional intervention. There was no difference in contrast(P>0.05). 2.There was no statistically significant difference between the preoperative group(55.47±18.55)points and the control group(53.03±6.66)points(t=0.643 2, P>0.05). There was no significant difference between the scores of(61.31 ±8.16)points and the control group(59.99±6.57)points(t=0.654 7, P>0.05). 3.There were 6 cases of adverse cardiac reactions in 27 cases in the study group and 8 cases of adverse reactions in the control group. There was no statistically significant difference between the groups(χ~2=0.385 7, P>0.05). Conclusion The application of facilitating PCI is more beneficial for the treatment of ST-segment elevation myocardial infarction.
引文
[1]Siontis Konstantinos C,Barsness Gregory W,Lennon Ryan J,et al.Pharmacoinvasive and Primary Percutaneous Coronary Intervention Strategies in ST-Elevation Myocardial Infarc tion(from the Mayo Clinic STEMI Network)[J].The American Journal of Cardiology,2016,117(12):1904-1910.
[2]Jonathan R Studnek,Allison Infinger,Hadley Wilson,et al.Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mort ality[J].Prehospital Emergency Care,2018,22(6):669-675.
[3]Thomas Michael P,Bates Eric R.Update on primary PCI for patients with STEMI[J].Trends in Cardiovascular Medicine,2017,27(2):95-102.
[4]刘庆东,耿继飞.参附注射液联合瑞替普酶溶栓治疗急性ST段抬高型心肌梗死的疗效观察[J].中国中医急症,2017,26(4):702-704.
[5]李昂,贾翠.瑞替普酶和尿激酶治疗急性心肌梗死的疗效和安全性分析[J].临床研究,2016,24(4):27-28.
[6]董修禄.瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的临床价值[J].河南医学研究,2016,25(6):1076-1076.
[7]俞飞虎,晏彪,林克强,等.急性ST段抬高型心肌梗死溶栓后早期介入治疗的临床疗效[J].浙江实用医学,2018,23(3):166-169.
[8]孙爱萍.瑞替普酶静脉溶栓后即刻与延迟PCI治疗急性ST抬高型心肌梗死的临床效果[J].临床医学研究与实践,2018,3(33):45-46.
[9]钟林岐.阿替普酶溶栓在急诊心肌梗死治疗中的效果研究及预后的影响研究[J].医药前沿,2018,8(11):251.
[10]陈华山,陈振云,刘祖秋.瑞替普酶溶栓后早期行PCI治疗STEMI临床观察[J].心脑血管病防治,2014(6):510-512.
[11]张冠君.急性ST段抬高型心肌梗死患者不同再通策略达到TIMI3级血流后心肌梗死面积的对比研究[D].石家庄:河北医科大学,2012.
[12]陈平,丛裴,赵宝河.替格瑞洛联合瑞替普酶治疗急性ST段抬高型心肌梗死的疗效和安全性分析[J].中国保健营养,2018,28(32):298.
[13]辛开荣,周青,宋宏宁,等.分层应变技术评估急性冠状动脉综合征患者经皮冠状动脉介入治疗术后左室收缩功能[J].临床超声医学杂志,2018,20(12):802-806.
[2]Jonathan R Studnek,Allison Infinger,Hadley Wilson,et al.Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mort ality[J].Prehospital Emergency Care,2018,22(6):669-675.
[3]Thomas Michael P,Bates Eric R.Update on primary PCI for patients with STEMI[J].Trends in Cardiovascular Medicine,2017,27(2):95-102.
[4]刘庆东,耿继飞.参附注射液联合瑞替普酶溶栓治疗急性ST段抬高型心肌梗死的疗效观察[J].中国中医急症,2017,26(4):702-704.
[5]李昂,贾翠.瑞替普酶和尿激酶治疗急性心肌梗死的疗效和安全性分析[J].临床研究,2016,24(4):27-28.
[6]董修禄.瑞替普酶联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的临床价值[J].河南医学研究,2016,25(6):1076-1076.
[7]俞飞虎,晏彪,林克强,等.急性ST段抬高型心肌梗死溶栓后早期介入治疗的临床疗效[J].浙江实用医学,2018,23(3):166-169.
[8]孙爱萍.瑞替普酶静脉溶栓后即刻与延迟PCI治疗急性ST抬高型心肌梗死的临床效果[J].临床医学研究与实践,2018,3(33):45-46.
[9]钟林岐.阿替普酶溶栓在急诊心肌梗死治疗中的效果研究及预后的影响研究[J].医药前沿,2018,8(11):251.
[10]陈华山,陈振云,刘祖秋.瑞替普酶溶栓后早期行PCI治疗STEMI临床观察[J].心脑血管病防治,2014(6):510-512.
[11]张冠君.急性ST段抬高型心肌梗死患者不同再通策略达到TIMI3级血流后心肌梗死面积的对比研究[D].石家庄:河北医科大学,2012.
[12]陈平,丛裴,赵宝河.替格瑞洛联合瑞替普酶治疗急性ST段抬高型心肌梗死的疗效和安全性分析[J].中国保健营养,2018,28(32):298.
[13]辛开荣,周青,宋宏宁,等.分层应变技术评估急性冠状动脉综合征患者经皮冠状动脉介入治疗术后左室收缩功能[J].临床超声医学杂志,2018,20(12):802-806.