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目的评价急性心肌梗死(AMI)患者应用小剂量溶栓剂重组组织型纤溶酶原激活剂(rt-PA)联合经皮冠状动脉介入治疗(PCI)的疗效和安全性。方法2005年4月至2006年4月,首都医科大学附属北京安贞医院116例首次AMI患者随机分为接受小剂量溶栓联合PCI治疗(小剂量易化PCI)组和直接PCI治疗组,69例患者接受静脉rt-PA50mg溶栓加PCI治疗,47例患者行直接PCI治疗。比较两组患者PCI前后梗死相关血管(IRA)开通率、出院前左室射血分数(LVEF)、住院期间出血事件、主要心脏不良事件(MACE)发生率。结果两组患者自入院至PCI时间比较差异无统计学意义;首次冠状动脉造影显示小剂量溶栓易化PCI治疗组PCI术前IRA开通率和血管床灌注评分(TIMI)3级血流率明显高于直接PCI组(44.7%对21.7%,P<0.05;34.0%对10.1%,P<0.05);小剂量易化PCI组术后TIMI3级血流率和出院前LVEF明显高于直接PCI治疗组[95.9%对85.9%,P<0.05;(65.2±7.6)%对(50.4±14.3)%,P<0.05];两组患者MACE发生率和住院期间主要出血事件发生率比较差异无统计学意义(P>0.05)。结论小剂量易化PCI治疗AMI安全有效,早期再通率高,有利于保护心室功能,且不增加MACE和出血并发症。
Objective To evaluate the efficacy and safety of low-dose thrombolytic therapy of recombinant tissue plasminogen activator (rt-PA) and percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods From April 2005 to April 2006, the first AMI patients in 116 cases of Beijing Anzhen Hospital affiliated to Capital Medical University were randomly divided into low-dose thrombolysis combined with PCI (low-dose group) and PCI group Patients received intravenous rt-PA 50mg thrombolysis plus PCI, 47 patients underwent direct PCI. The incidence of infarction-related vascular (IRA) opening, pre-discharge left ventricular ejection fraction (LVEF), in-hospital bleeding and major cardiac adverse events (MACE) were compared between the two groups. Results There was no significant difference in the time from hospital admission to PCI between the two groups. The first coronary angiography showed that the rate of opening of IRA and the grade 3 blood flow rate of TIMI in PCI group were significantly lower (44.7% vs 21.7%, P <0.05; 34.0% vs 10.1%, P <0.05). The postoperative TIMI grade 3 blood flow rate and LVEF before discharge in PCI group were significantly higher than those in direct PCI group (95.9% vs 85.9%, P <0.05; (65.2 ± 7.6)% vs (50.4 ± 14.3%), P <0.05]. There was no significant difference in the incidence of MACE between two groups and the incidence of major bleeding during hospitalization Significance (P> 0.05). Conclusions Small doses of PCI is safe and effective in treating AMI. The early recanalization rate is good for protecting ventricular function without increasing MACE and bleeding complications.