标题：急性心肌梗死患者急诊介入治疗的近期临床效果评价

      作者：甘文树，周练兴，陆超灵，黄彩燕    (贺州市人民医院急诊科，广西 贺州 542899)

      卷次： 2018年29卷17期

      【摘要】 目的 观察急诊经皮冠状动脉介入治疗(PCI)对急性 ST段抬高型心肌梗死患者的近期临床疗效。方法 回顾性分析贺州市人民医院急诊科 2015年 1月至 2017年 10月收治的 90例急性ST段抬高型心肌梗死患者的临床资料，根据治疗方法的不同，将45例接受PCI治疗者纳入观察组，45例接受尿激酶静脉溶栓治疗者纳入对照组，比较两组患者的闭塞血管再通率、心超指标[如左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)]、出血发生率和主要心血管不良事件(MACE)的发生率。治疗后 3个月，记录 6 min步行距离，采用GQOL-74生活质量量表评价患者的生活质量。结果 观察组患者的闭塞再通率为 95.6%，明显高于对照组的60.0%，出血并发症发生率为4.4%，明显低于对照组的15.6%，MACE发生率为2.2%，明显低于对照组的15.6%，差异均有统计学意义(P<0.05)；治疗后，观察组患者的LVEF和LVEDD分别为(65.3±6.1)%、(57.2±3.2) mm，与对照组的(56.2±5.4)%、(63.8±4.3) mm比较差异均有统计学意义(P<0.05)。治疗后3个月，观察组患者的6 min步行距离及GQOL-74评分分别为(450.4±91.8) m、(62.9±6.7)分，明显高于对照组的(402.3±102.9) m、(58.4±5.2)分，差异均有统计学意义(P<0.05)。结论 急诊PCI治疗急性心肌梗死与静脉溶栓比较，可以更好的开通梗死相关血管，改善心功能及心室重构，降低了MACE的发生风险，改善患者的心功能及生活质量，且具有更好的安全性。
      【关键词】 急性心肌梗死；经皮冠状动脉介入；尿激酶；溶栓；主要心血管不良事件
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2018）17—2391—03

Recent clinical efficacy of emergency percutaneous coronary intervention for patients with acute myocardialinfarction.
GAN Wen-shu, ZHOU Lian-xing, LU Chao-ling, HUANG Cai-yan. Department of Emergency, Hezhou People'sHospital, Hezhou 542899, Guangxi, CHINA
【Abstract】 Objective To investigate the recent clinical efficacy of emergency percutaneous coronary interven-tion (PCI) for patients with acute ST segment elevation myocardial infarction (STEMI). Methods The clinical data of90 patients with acute STEMI treated in Hezhou People's Hospital from January 2015 to October 2017 were analyzed ret-rospectively. According to the different treatment methods, 45 patients treated with PCI were included into the observa-tion group, and 45 patients received intravenous thrombolytic therapy in control group. The occluded vascular recanaliza-tion rate, and the cardiac super indexes (such as left ventricular ejection fraction [LVEF] and left ventricular end diastolicdiameter [LVEDD]), the incidence of bleeding and the incidence of major cardiovascular adverse events (MACE) werecompared between the two groups. After 3 months of treatment, the 6 min walking distance was recorded and the qualityof life (QOL) was evaluated by GQOL-74. Results The occluded vascular recanalization rate in the observation groupwas 95.6%, which was significantly higher than 60.0% in the control group; But the bleeding complications rate andMACE incidence were 4.4% and 2.2%, respectively, which were significantly lower than 15.6% and 15.6% in the con-trol group (P<0.05). After treatment, the LVEF and LVEDD in observation group respectively were (65.3±6.1)%, (57.2±3.2) mm, respectively, which were significantly lower than (56.2±5.4)% and (63.8±4.3) mm in control group (P<0.05).After 3 months of treatment, the 6 min walking distance and GQOL-74 score in the observation group were (450.4±91.8) m and (62.9±6.7), respectively, which were significantly higher than (402.3±102.9) m and (58.4±5.2) in the controlgroup (P<0.05). Conclusion Compared with intravenous thrombolytic therapy, emergency PCI can better open in-farct-related blood vessels, improve cardiac function and ventricular remodeling, reduce the risk of MACE, improve car-diac function and quality of life of patients, with better safety.
      【Key words】 Acute myocardial infarction (AMI); Percutaneous coronary intervention (PCI); Urokinase; Throm-bolytic; Major adverse cardiovascular events (MACE)·论 著·doi:10.3969/j.issn.1003-6350.2018.17.007