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目的比较直接经皮冠状动脉内介入治疗(PCI)、静脉溶栓+PCI(补救性PCI)、静脉溶栓与传统疗法治疗急性心肌梗死(AMI)的临床疗效。方法回顾分析AMI患者96例,其中25例患者接受静脉溶栓治疗,22例患者接受直接PCI治疗,31例行补救性PCI,18例接受传统疗法。比较4组患者梗死相关血管(IRA)再通率与住院死亡率。结果4组患者IRA再通率:直接PCI组IRA再通率达100%,与补救性PCI组比较没有显著性差异(P>0.05),但明显高于溶栓治疗组和传统治疗组(P<0.05)。溶栓治疗组IRA再通率显著高于传统治疗组;4组患者住院死亡率:补救性PCI组住院死亡率略低于直接PCI组,两组比较无显著性差异;补救性PCI组和直接PCI组住院死亡率均显著低于溶栓治疗组和传统治疗组(P<0.05);溶栓治疗组住院死亡率与传统治疗组相比差异有显著性,P<0.05。结论与传统治疗相比,尿激酶静脉溶栓IRA再通率高、死亡率低。与溶栓治疗比较,直接PCI能使IRA安全有效充分开通,可更好地改善患者心功能,降低住院死亡率。补救PCI也能有效地开通IRA,获得TIMI3级血流,挽救濒死心肌,改善心功能。
Objective To compare the clinical effects of direct percutaneous coronary intervention (PCI), intravenous thrombolysis + PCI (rescue PCI), intravenous thrombolysis and conventional therapy in the treatment of acute myocardial infarction (AMI). Methods A total of 96 AMI patients were retrospectively analyzed. Among them, 25 patients received intravenous thrombolysis, 22 received direct PCI, 31 received rescue PCI, and 18 received conventional therapy. The recanalization rate and hospital mortality of infarction-related blood vessels (IRA) in 4 groups were compared. Results The IRA recanalization rate was 100% in the direct PCI group, which was not significantly different from that in the PCI group (P> 0.05), but significantly higher than that in the thrombolytic therapy group and the traditional therapy group (P <0.05) ). The recanalization rate of IRA in the thrombolytic therapy group was significantly higher than that in the traditional therapy group. The in-hospital mortality rate in the 4 groups was slightly lower than that of the direct PCI group in the rescue PCI group. There was no significant difference between the two groups The in-hospital mortality rate in PCI group was significantly lower than that in thrombolytic therapy group and traditional treatment group (P <0.05). The difference between in-hospital mortality rate and thrombolysis therapy group was significant (P <0.05). Conclusion Compared with traditional treatment, urokinase intravenous thrombolysis IRA recanalization rate is high, mortality is low. Compared with thrombolytic therapy, direct PCI can make IRA safe and effective fully open, can better improve patient’s cardiac function, reduce hospital mortality. Remedy PCI can also effectively open the IRA, access TIMI3 grade blood flow, save the dying myocardium, improve cardiac function.