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目的研究基层医院急性ST段抬高性心肌梗死(STEMI)再灌注治疗的策略。方法选择2011年8月~2013年7月于陆丰县人民医院接受治疗的ST段抬高性心肌梗死患者200例,依据计算机生成随机数字分为单独溶栓组(n=100),溶栓+PCI组(n=100)。单独溶栓组在常规治疗基础联合溶栓治疗,溶栓+PCI组在单独溶栓治疗的基础上行PCI治疗。观察两组治疗前与治疗7 d后左室收缩期末内径(LVESD)、左室舒张期末内径(LVEDD)、左室射血分数(LVEF),住院期间及治疗后半年、1年、2年内再梗死、再住院、死亡及治疗费用。结果治疗7d后,单独溶栓组LVESD、LVEDD均高于溶栓+PCI组,LVEF低于溶栓+PCI组,差异有统计学意义(P<0.05)。治疗1年、2年后,单独溶栓组再梗死率高于溶栓+PCI组,差异有统计学意义(P<0.05)。治疗半年、1年、2年后,溶栓+PCI组再住院率、死亡率低于单独溶栓组,差异均有统计学意义(P<0.05)。单独溶栓组治疗总费用低于溶栓+PCI组,有统计学意义(P<0.05)。结论 STEMI溶栓治疗可快速改善患者心肌血供,且治疗费用相对较低,较为适合于难以快速运转患者的基层医院。但治疗时要恰当选择溶栓治疗的适应证,对需行PCI的患者需转行PCI治疗。
Objective To study the strategy of treating STEMI in primary hospital. Methods A total of 200 patients with ST-elevation myocardial infarction who were treated in Lufeng County People’s Hospital from August 2011 to July 2013 were randomly divided into thrombolytic group (n = 100), randomized thrombolysis + PCI group (n = 100). The thrombolytic therapy group and the PCI group were treated with PCI alone on the basis of thrombolytic therapy. The left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), duration of hospitalization and after 6 months, 1 year and 2 years Infarction, hospital readmission, death and treatment costs. Results After 7 days of treatment, LVESD and LVEDD in thrombolysis alone group were higher than those in thrombolytic thrombolysis group and LVEF group, respectively (P <0.05). At 1 year and 2 years after treatment, the reinfarction rate in thrombolytic group was higher than that in thrombolysis + PCI group (P <0.05). After 6 months, 1 year and 2 years of treatment, the rehospitalization rate and mortality of thrombolysis + PCI group were lower than those of thrombolysis alone group, the difference was statistically significant (P <0.05). The total cost of thrombolysis group was lower than that of thrombolysis + PCI group (P <0.05). Conclusion STEMI thrombolytic therapy can rapidly improve myocardial blood supply in patients with relatively low cost of treatment, which is suitable for primary hospitals that are difficult to operate rapidly. However, the appropriate choice of treatment of thrombolytic indications for patients in need of PCI need to switch to PCI treatment.