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目的研究急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)或溶栓治疗因死亡率及主要不良心血管事件(MACE)发生率的差异。为患者选择更合理的治疗方式提供客观依据。方法选择华北理工大学附属医院2012年1月-2014年12月收治的STEMI患者中符合入选标准的242例患者。按治疗方法分为2组,PCI组153例,溶栓组89例。比较2组的再灌注成功率、6个月后再梗死率、总病死率、出现并发症等情况,分析出现差异原因。结果与溶栓组比较,PCI组再灌注成功率明显提高(96.73%vs 76.40%),6个月后再梗死率(0 vs 8.99%)及总病死率(1.31%vs 7.87%)降低,并发症更少(3.92%vs 4.49%)6个月后左心功能恢复更佳。而各因素(年龄,血糖、血脂、血压、心率控制情况以及肾小球滤过率)对患者生存状态无相关,而与MACE事件相关的为再灌注时间。结论 PCI较溶栓治疗能显著降低STEMI患者死亡率及MACE发生率;而治疗的关键是缩短再灌注时间。
Objective To investigate the differences in the incidence of mortality and major adverse cardiac events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) or thrombolysis. For patients to choose a more reasonable treatment to provide an objective basis. Methods A total of 242 eligible patients were enrolled from STEMI patients from January 2012 to December 2014 in Affiliated Hospital of North China Polytechnic University. Divided into two groups according to the treatment method, PCI group 153 cases, 89 cases of thrombolytic group. The success rate of reperfusion, the reinfarction rate after 6 months, the total mortality and complications were compared between the two groups to analyze the causes of the difference. Results Compared with the thrombolysis group, the success rate of reperfusion in PCI group was significantly higher (96.73% vs 76.40%), and the reinfarction rate (0 vs 8.99%) and total mortality (6% vs 1.31% vs 7.87% Fewer symptoms (3.92% vs 4.49%) improved left ventricular function after 6 months. The factors (age, blood glucose, blood lipids, blood pressure, heart rate control, and glomerular filtration rate) were not related to the survival status of patients, and MACE events related to the reperfusion time. Conclusion Compared with thrombolytic therapy, PCI can significantly reduce the mortality and the incidence of MACE in patients with STEMI. The key to treatment is to shorten the reperfusion time.