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目的:了解溶栓治疗后冠状动脉再通的临床标准的准确性。方法:以冠状动脉造影为标准,对冠状动脉再通的临床标准进行双盲诊断试验研究。73例急性心肌梗死患者在静脉溶栓治疗后2小时内接受冠状动脉造影检查。结果:以《中华心血管病杂志》编委会推荐的参考方案的标准判断40例再通,33例未通;以冠状动脉造影判断44例再通,29例未通。参考方案标准的敏感度为68.2%,特异度为65.5%,临床准确度为67.1%。结论:目前临床沿用的参考方案的标准是较好的判断标准。试图改变其中某些标准的方法不能增加其敏感度和准确度。在对假阳性及假阴性患者进行分析时发现:ST段在溶栓治疗后2小时内不能迅速下降是影响其临床准确度的原因;不同类型心律失常预报临床再通的价值不同,且与心肌梗死部位有关。
OBJECTIVES: To understand the accuracy of the clinical criteria for coronary recanalization following thrombolytic therapy. Methods: Double-blind diagnostic test was performed on the clinical criteria of coronary recanalization with coronary angiography as the standard. 73 patients with acute myocardial infarction underwent coronary angiography within 2 hours after intravenous thrombolysis. Results: According to the standard recommended by the editorial board of “Journal of Cardiovascular Diseases of China”, 40 cases were recanalized and 33 cases were failed; 44 cases were recanalized by coronary angiography, and 29 cases failed. The sensitivity of the reference protocol standard was 68.2%, the specificity was 65.5% and the clinical accuracy was 67.1%. Conclusion: The standard of clinical reference scheme is a better criterion. Attempts to change some of these standards do not increase their sensitivity and accuracy. Analysis of false-positive and false-negative patients found that: ST segment in 2 hours after thrombolytic therapy can not be rapidly decreased is the clinical accuracy of the reasons; different types of arrhythmia prediction clinical recanalization of different values, and with myocardial infarction related.