姚鸿立　屈锐毅　张佩生

【摘要】 目的 观察急诊直接经皮冠状动脉介入治疗(PCI)和静脉溶通后行延迟PCI冠脉血运重建术治疗急性心肌梗死(AMI)的疗效及并发症。方法 因AMI住院并接受PCI治疗者72例，急诊直接PCI者20例，溶栓后梗死相关血管开通行延迟PCI者52例，直接PCI者仅处理梗死相关血管，延迟PCI者除处理梗死相关血管外，对严重狭窄的非梗死相关血管也同时进行了处理。术后随访12~24个月，观察心血管事件的发生情况。结果 直接PCI和延迟PCI的梗死相关血管均成功开通血运重建，手术成功率100%。术中梗死相关冠脉血运重建术后即刻血管慢复流的发生率直接PCI组较延迟PCI组高(P<0．05)，术后随访期间，7例术后6个月内发生心绞痛，5例为直接PCI，2例为延迟PCI。无再梗和死亡病例发生。结论 PCI是治疗AMI 的有效方法，手术成功率高，并发症少，急诊直接PCI术中冠脉血管重建术后即刻血管慢复流的发生率较延迟PCI者高，选择性的对病变血管采取PCI能取得非常好的疗效。

【关键词】急性心肌梗死；介入治疗

Safety efficacy comparison between direct or late elective percutaneous coronary intervention in 72 patients with acute myocardial infarction

YAO Hong-li,QU Rui-yi,ZHANG Pei-sheng.Deparement of Cardiology， The Fifth Affiliated Hospital of Zhengzhou university.zhengzhou 450052,China

【Abstract】 Objective To evaluate the efficacy and complications of different plans of percutaneous coronary revascularization in acute myocardial infarction(AMI).Methods Total 72 patients with AMI received 2 different plans of percutaneous coronary intervention(PCI),direct PCI in 20 patients,and late elective PCI in 52 patients who were successfully angiograghic reperfusion after intravenous thrombolysis.They were followed up for 24 months,and cardiovascular events were observed.Results The infarct related arteries were successful re-opened in all 72 patients.In some elective PCI patients,the severe stenotic non-infarct related arteries were completely dilated.The rates of slow-flow phenomenon in direct PCI group were higher than that in elective PCI group(P<0．05).There was no serious complication during procedures.During 24 months fillow-up,there was no death or recurrent AMI.Angina pectoris was observed in 7 patients 6 months after PCI,5 patients in direct PCI group and 2 patients in elective PCI group(P<0．05).Conclusion percutaneous coronary revascularization in AMI has a higher success rate and fewer serious complications.Compared with elective PCI,the emergent PCI may have a higher rate of slow-flow phenomenon and angina pectoris during follow-up.

【Key words】Acute myocardial infarction; Percutaneous coronary intervention

经皮冠脉介入治疗(PCI)现已成为治疗急性心肌梗死(AMI)的一种有效方法。本研究旨在观察直接PCI和溶栓后延迟PCI治疗两种不同时期血运重建术在治疗AMI的疗效及其并发症。

1 对象与方法

1．1 研究对象 郑州大学第五附属医院自2002年5月至2005年5月因急性心肌梗死住院并接受PCI术者72例，男61例，女11例，年龄41~75(58．2±10．7)岁，其中直接PCI者20例，溶栓再通后行择期延迟PCI者52例，梗死部位：前壁46例(63．8%)，高侧壁4例(5．6%)，下壁、正后壁及右室22例(30．6%)。术前Killip心功能分级：Ⅰ级62例(86．1%)，Ⅱ级9例(12．5%)，Ⅲ级1例(1．4%)。

1．2 研究方法 所有患者符合急性心肌梗死(AMI)诊断标准^[1]：①持续缺血性胸疼、胸闷≥30 min;②相邻两个或以上连续导联ST段明显上抬，肢导联>0．1 mv,胸导>0．2 mv,且心电图有动态演变;③CK-MB水平≥2倍高限值;④肌钙蛋白呈阳性;⑤自发病至开始干预的时间均在6 h以内。依据临床情况分别给予直接PCI或静脉溶栓(尿激酶150万U0．5 h内滴完)治疗。其中……