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目的 探讨直接、延迟经皮冠状动脉成形( PTCA) /支架植入术 ( STENTING)与静脉溶栓术三种治疗方法对急性心肌梗死 ( AMI)患者近远期疗效的差异。 方法 1 998年 1 0月至 2 0 0 0年 6月我院收治的 AMI患者 5 3例分为直接 PTCA/STENTING组 1 6例 ( A组 )、延迟 PTCA/STENT-ING组 1 7例 ( B组 )、静脉溶栓组 2 0例 ( C组 )。均于入院后即给予相同的常规术前处理 ,B组先采用与C组相同的静脉溶栓治疗 (日本产 Green Cross尿激酶 96～ 1 2 0万 IU) ,3～ 7d(平均 3.5± 1 .2 d)后行延迟 PTCA/STENTING治疗。采用第四军医大学BASE软件包 ,对三组间的计数资料进行方差分析+ Student- Newman’s检验 ,对三组间的计量资料进行 χ2 + t检验两两比较。 结果 ( 1 )一般资料如年龄、性别、发病至开始介入 /溶栓治疗时间、心肌梗死部位、相关梗塞动脉、植入支架数等指标三组间均无统计学差异 ( P>0 .0 5 ) ,三组可比。 ( 2 )血管再通率A、B两组 ( 1 0 0 % )介入治疗后显著高于 C组 ( 65 % )(P<0 .0 1 ) ,B组介入治疗前的溶栓再通率与 C组无差异 ;PTCA/STENTING成功率 A、B两组分别为 1 0 0 % /93.8%、1 0 0 % /94.1 %。( 3)介入 /溶栓治疗后心肌酶学峰值 ( CK/CK- MB)出现时间 A组显著提前于 B、C两组 ( P<0 .0 1 )
Objective To investigate the short-term and long-term effects of direct and delayed PTCA / STENTING and intravenous thrombolysis on patients with acute myocardial infarction (AMI). Methods From January 1998 to June 2000, 53 patients with AMI admitted to our hospital were divided into direct PTCA / STENTING group of 16 cases (group A) and delayed PTCA / STENT-ING group of 17 patients (group A) B group), intravenous thrombolysis group 20 cases (C group). The same routine preoperative treatment was given after admission. Group B received the same intravenous thrombolytic therapy (96-120,000 IU of Green Cross urokinase in Japan) and 3 to 7 days (mean 3.5 ± 1 .2 d) Delayed PTCA / STENTING treatment. The Fourth Military Medical University BASE software package, the count data between the three groups were analyzed by ANOVA + Student-Newman’s test, the measurement data between the three groups χ2 + t test pairwise comparison. Results (1) There was no significant difference in general data such as age, gender, onset to intervention / thrombolysis time, myocardial infarction, related infarct artery, number of implanted scaffolds and other three groups (P> 0.05) ), Three groups comparable. (2) The rate of revascularization was significantly higher in group A and B (100%) than that in group C (65%) (P <0.01), and the rate of thrombolysis before intervention in group B There was no difference with group C; the success rate of PTCA / STENTING was 100% /93.8%, 100% /94.1% in groups A and B, respectively. (3) The onset time of myocardial enzymatic peak (CK / CK-MB) after interventional / thrombolytic therapy was significantly earlier in group A than in group B and C (P <0.01)