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逆向溶栓联合PCI术对急性ST段抬高型心肌梗死的疗效观察 被引量:3

Observation of curative effect of reverse thrombolysis combined with PCI on acute ST - segment elevation myocardial infarction
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摘要 目的观察逆向溶栓联合经皮冠状动脉介入治疗(PCI)术对急性ST段抬高型心肌梗死(STEMI)心肌的疗效。方法将48例急性STEMI患者随机分成逆向溶栓联合PCI组和直接PCI组(每组各24例),逆向溶栓联合PCI术是指经微导管将尿激酶原注射至闭塞段以远进行逆向溶栓,然后再进行PCI,比较两种方法中慢血流无复流的发生率、再灌注心律失常的发生率和出血发生率。结果逆向溶栓联合PCI组出现1例慢血流,PCI术后1例出现一过性心动过缓,而PCI组出现3例慢血流,2例无复流,PCI术后6例出现室一过性室速,2例给予电复律,2例出现一过性心动过缓;两组均无脑出血、消化道出血等情况,2例患者出现反复心力衰竭症状。两组比较术后慢血流无复流的发生率(P=0.013),再灌注心律失常的发生率有明显的统计学意义(P=0.001),出血的发生率无统计意义(P=1.000)。结论对于急性STEMI患者,逆向溶栓联合PCI术能够明显减少慢血流无复流及再灌注心律失常的发生,从而改善患者的远期预后,同时并未增加出血等并发症的发生率。 Objective To observe the effect of reverse thrombolysis combined with PCI on acute ST - segment elevation myocardial infarction. Methods 48 patients with acute ST - segment elevation myocardial infaretion were randomly divided into two groups: reverse thrombolysis eombined with PCI group and direct PCI group, including 24 patients respectively. Reverse thrombolysis eombined with PCI means that pro - urokinase is injected into the occlusion segment for reverse thrombolysis, then PCI is performed. The incidences of slow - flow and no - reflow, the incidence of reperfusion arrhythmia, the incidence of bleeding in the two methods were compared. Results In the reverse thrombolysis combined with PCI group, slow -reflow in 1 case, transient bradyeardia after PCI in 1 case, while in PCI group, slow - reflow in 3 cases, no - reflow in 2 cases, transient ventrieular taehyeardia after PCI in 6 cases, electrical conversion given to 2 cases, transient bradycardia in 2 cases, no cerebral hemorrhage and gastrointestinal bleeding occurring in both groups, and symptoms of repeated heart failure oecurring in 2 cases. After comparison of both groups, the incidence of postoperative slow - reflow and no - reflow (P = 0. 013 ) , and the incidence of reperfusion arrhythmia (P = 0. 0(31 ) were statistically significant, and the incidence of bleeding (P = 1. 000) was of no statistical significance. Conclusions With regard to the acute ST - segment elevation myocardial infarction, reverse thrombolysis combined with PCI can significantly reduce the occurrence of slow - reflow and no - reflow and reperfusion arrhythmia, and thus improve the long - term prognosis of patients, without increasing the incidence of bleeding and other complications.
作者 郭自同 沈鑫 王钊 阿木提 穆叶赛 雷建新 周立英 余小林 赖红梅 阿德力江 阿斯卡尔 李国庆 Guo Zi - tong, Shen Xin, Wang Zhao, A Mu - ti, Mu Ye - sai, Lei Jian - xin, Zhou Li - ying, Yu Xiao - lin, Lai Hong - mei, A De - li -jiang, A Si - ka - er, Li Guo - qing.( Department of Cardiology, People's Hospital of Xinjiang Autonomous Region, Wulumuqi 830001, China)
出处 《中国急救医学》 CSCD 北大核心 2017年第5期454-457,共4页 Chinese Journal of Critical Care Medicine
基金 国家自然科学基金课题(81160029)
关键词 逆向溶栓 无复流 再灌注心律失常 ST段抬高型心肌梗死(STEMI) 经皮冠状动脉介入(PCI) Reverse thrombolysis No - reperfusion Reperfusion arrhythmia ST segmentelevation myocardial infarction ( STEMI ) Percutaneous coronary intervention( PCI )
作者简介 郭自同(1982-),男,硕士,主治医师,E—mail:guozitong1982@163.com。 通信作者:李国庆(1961-),男,主任医师,教授,博士生导师,E—mail:xjlqgvip@126.com。
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