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目的观察逆向溶栓联合冠脉支架植入术(PCI)治疗急性ST段抬高型心肌梗死急性心肌的1a随访结果。方法将116例急性ST段抬高型心肌梗死患者随机分成逆向溶栓联合PCI组(56例)和直接PCI组(60例),逆向溶栓联合PCI术经微导管将尿激酶原注射至闭塞段以远进行逆向溶栓,然后再行PCI,直接PCI组对靶病变血管行常规PCI术,术后进行为期1a的随访,比较2组术后即刻冠状动脉血流及心肌灌注情况,1a内主要心脏不良事件(MACE)发生率及左心室收缩功能变化。结果逆向溶栓联PCI组出现慢复流所占比例(3.6%)明显低于直接PCI组(20%)(P=0.003);逆向溶栓联合PCI组2h心电图ST段回落>50%患者所占比例(60.7%)高于直接PCI组(38.3%)(P=0.016);住院期间逆向溶栓联合PCI组射血分数[(49±9)%]高于直接PCI组[(45.8±8.6)%],2组比较差异有统计学意义(P=0.018);住院期间逆向溶栓联合PCI组左心室舒张期末内径(LVEDd)[(44.5±7.4)mm]低于直接PCI组[(46.4±8.2)mm],2组比较差异均有统计学意义(P=0.016);逆向溶栓联合PCI组在1个月、3个月、1a心脏超声测量的左心室射血分数(LVEF)均高于直接PCI组,差异有统计学意义(P<0.05),逆向溶栓联合PCI组在1个月、3个月、1a心脏超声测量的LVEDd、脑钠肽(NT-proBNP)均低于直接PCI组,差异有统计学意义(P<0.05);2组患者随访1a后心源性死亡、严重心力衰竭的发生率,差异无统计学意义。结论对于ST段抬高性心肌梗死,采用逆向溶栓联合PCI术治疗可能降低慢血流、无复流的发生率,改善左心室收缩功能,对改善患者的长期预后可能有一定的帮助。
Objective To observe the follow-up results of retrograde thrombolysis and coronary stenting (PCI) in the treatment of acute myocardial infarction with acute ST-segment elevation myocardial infarction. Methods One hundred and sixty-one patients with acute ST-segment elevation myocardial infarction were randomly divided into reverse thrombolysis combined with PCI group (56 cases) and direct PCI group (60 cases). Urokinase was injected into the occlusion by reverse thrombolysis combined with PCI through microcatheter And then further PCI. The PCI group was followed up PCI for the target lesion vessels. After a follow-up of 1a, the coronary blood flow and myocardial perfusion were compared between the two groups immediately The incidence of major cardiac adverse events (MACE) and changes in left ventricular systolic function. Results The rate of slow reflow in the reverse thrombolysis combined PCI group was significantly lower than that in the direct PCI group (20%) (P = 0.003) (60.7%) was higher than that of the direct PCI group (38.3%) (P = 0.016). The ejection fraction of the patients treated with reverse thrombolysis combined with PCI during hospitalization (49 ± 9%) was higher than that of the direct PCI group (45.8 ± 8.6% ), There was a significant difference between the two groups (P = 0.018). LVEDd [(44.5 ± 7.4) mm] in the group treated with reverse thrombolysis and PCI during hospitalization was lower than that in the direct PCI group [(46.4 ± 8.2) mm]. There was significant difference between the two groups (P = 0.016). Left ventricular ejection fraction (LVEF) at 1 month, 3 months, 1a cardiac ultrasound in the reverse thrombolysis combined with PCI group (P <0.05). LVEDd and NT-proBNP in 1-month and 3-month retrospective thrombolysis combined with PCI group were lower than those in direct PCI group Direct PCI group, the difference was statistically significant (P <0.05); 2 groups of patients after follow-up of 1a cardiac death, the incidence of severe heart failure, the difference was not statistically significant. Conclusion The treatment of ST-segment elevation myocardial infarction with reverse thrombolysis and PCI may reduce the incidence of slow blood flow and no-reflow, and improve the left ventricular systolic function, which may be helpful to improve the long-term prognosis of patients.