天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (12): 1428-1432.doi: 10.11958/j.issn.0253-9896.2015.12.022

• 临床研究 • 上一篇    下一篇

溶栓后PCI 与pPCI 治疗急性ST 段抬高型心肌梗死的效果观察

陈湾湾1,2，姚朱华2，马梅3，程立松2，周馨2，杜建平2，庞志华2   

  1. 1 天津医科大学研究生院（邮编300070）；2 天津市人民医院心内科；3 天津中医药研究院附属医院
  • 收稿日期:2015-08-07 修回日期:2015-09-06 出版日期:2015-12-15 发布日期:2015-12-11
  • 作者简介:陈湾湾（1989），女，硕士在读，主要从事心血管病的诊疗与临床研究

Effect of PCI after thrombolysis and primary PCI on the treatment of acute ST elevation myocardial infarction

CHEN Wanwan1,2, YAO Zhuhua2, MA Mei3, CHENG Lisong2, ZHOU Xin2, DU Jianping2, PANG Zhihua2   

  1. 1 Postgraduate School of Tianjin Medical University, Tianjin 300070, China; 2 Tianjin Union Medicine Center, Department of Cardiology; 3 Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital
  • Received:2015-08-07 Revised:2015-09-06 Published:2015-12-15 Online:2015-12-11

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摘要： 目的探讨静脉溶栓后早期经皮冠状动脉介入治疗(PCI)与直接PCI(pPCI)治疗急性ST 段抬高型心肌梗死 (STEMI)的临床效果及安全性的差异。方法选取发病12 h 内的STEMI 患者215 例，根据先前是否接受注射用重组人尿激酶原静脉溶栓治疗，分为溶栓后早期PCI 组(68 例)和pPCI 组(147 例)。比较2 组PCI 治疗前后梗死相关血管 (IRA)的即刻TIMI 血流分级、术后校正的TIMI 计帧数(CTFC)及TIMI 心肌灌注分级(TMPG)；观察住院期间出血并发症、术后6 个月时左心室功能及主要心脏不良事件(MACE)发生情况。结果2 组基线数据无明显差异。溶栓后早期PCI 组的术前TIMI 血流2～3 级比例明显高于pPCI 组(77.9% vs 20.4%,P < 0.05）；PCI 术后，2 组TIMI 血流2～3 级者的比例无明显差异(P > 0.05)。早期PCI 组TMPG3 级的比例高于pPCI 组(82.4% vs 68.7%, P < 0.05），术后CTFC 低于pPCI 组[(27.7±5.0)帧vs (32.6±7.1)帧,P<0.05]，肌酸激酶同工酶(CK-MB)峰值低于pPCI 组[(225.8±108.3) U/L vs (283.4±110.6) U/L，P<0.05]。2 组患者住院期间出血并发症及MACE 发生率、随访6 个月时左心功能比较无明显差异(P > 0.05)，但2 组术后3、6 个月的左室射血分数（LVEF）均高于术前，溶栓后早期PCI 组术后1、3、6 个月的左室舒张末期内径(LVEDd)低于术前(P < 0.05)，pPCI 组术后3、6 个月的LVEDd 低于术前(P < 0.05)。结论不能及时施行pPCI 的STEMI 患者，应用注射用重组人尿激酶原溶栓后早期PCI 不增加出血及MACE 发生风险，且在改善近期心功能方面的获益与pPCI 相当，是一种安全有效的替代再灌注策略。

关键词: ST 段抬高型心肌梗死, 溶栓, 注射用重组人尿激酶原, 经皮冠脉介入治疗, 主要心脏不良事件

Abstract: Objective To investigate the differences in clinical efficacy and safety between thrombolysis followed PCI (percutaneous coronary intervention) and primary PCI in patients with acute STEMI（ST elevation myocardial infarction）. Methods A total of 215 STEMI patients who visit our clinic within 12 h since onset of their symptoms from May 2013 to January 2015 were enrolled. All eligible patients were divided into Early PCI group(n=68) and pPCI group (n=147) based on whether or not they received injection of recombinant human prourokinase thrombolytic therapy before their visit. Immediate TIMI (Thrombolysis In Myocardial Infarction) flow grade of infarct-related artery (IRA) before and after PCI treatment, post⁃ operative CTFC (Corrected TIMI Frame Count) and TMPG (TIMI myocardial perfusion grade) were compared between these two groups. The incidence of bleeding during hospital stay , left ventricular function at 6 month after intervention and major adverse cardiac events (MACE) were all observed. Rusults There is no obvious difference between the baseline of two groups. Before PCI, the proportion of TIMI grade 2-3 was higher in Early PCI group (77.9% vs 20.4%,P < 0.05）than that in pPCI group; but there was no significant difference in the proportion of TIMI grade 2-3 between these two groups after PCI (P > 0.05). CTFC and peak value of serum CK-MB were lower [(27.7±5.0) vs (32.6±7.1), P < 0.05; (225.8±108.3) U/L vs (283.4±110.6) U/L, P < 0.05] and rate of TMPG 3 is higher (82.4% vs 68.7%, P < 0.05）in Early PCI group than those in pPCI group. No significant difference was found in the incidence of bleeding and MACE during hospital stay and Left ventric⁃ ular function at 6 months after operation between these two groups. By contrast, LVEFs were higher while LVEDds (LVED diameter) were lower after 3 and 6 months of the intervention compared to those before intervention in both groups (P < 0.05). Conclusion It is a safe and effective reperfusion strategy for STEMI patients to receive rhPro-UK thrombolytic thera⁃ py followed early PCI as an alternative way to those who failed to receive pPCI on time. It didn′t increase the occurrence of bleeding complications and MACE, and at the same time it presented the same benefit in improving recent cardiac function as pPCI did.

Key words: ST-segment elevation myocardial infarction, thrombolysis, recombinant human prourokinase, percutaneous coronary intervention, major adverse cardiac events