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1、中国循环杂志201年3月第19卷增刊直接经皮冠状动脉介入治疗与溶栓后即刻和补救经皮冠状动脉介入治疗对急性心肌梗死患者近期心功能的影响曲鹏李永旺邓根群摘要目的:评价直接经皮冠状动脉介人治疗(PCI)与小剂量重组组织型纤溶酶原激活物(rt-PA)溶栓后即刻和补救PCI对急性心肌梗死(AMI)患者的有效性和安全性，并观察其对近期左心室重构及功能的影响。方法:对初次发病、发病6h内且无溶栓禁忌证的AMI患者63例随机给予直接PCI直接PCI组，32例)或小剂量rt-PA溶栓加即刻和补救PCI溶栓加补救PC
2、I组，31例)治疗，于术后3d,30d,90d行二维超声心动图检查并记录有关心脏事件。结果:术后3d,30d,90d两组间左心室收缩末期容积指数(ESVI)、左心室舒张末期容积指数(EDSI)、左心室射血分数(EF)和室壁运动指数(WMSI)均无显著差异(P>0.05);各组内30d,90d与3d比较均有显著差异;依据首次造影血流是否达心肌梗死溶栓治疗临床试验(TIMI)3级将所有患者再分为两组。首次造影达”MI血流3级者与未达TIMI3级者30d,90d各指标均显著改善。结论:直接PCI与小剂量
3、rt-PA溶栓后即刻和补救PCI同样安全有效，改善左心室功能并降低心脏事件的发生。关键词心肌梗塞血管成形术，经腔，经皮冠状动脉溶栓治疗心功能EffectofPrimaryPercutaneousCoronaryInterventionandRescueAngioplastyPostThrombolysisonLeftVentricularFunctionWithAcuteMyocardialInfarctionQuPeng,LiYongwang,DengGenqun.DepartmentofCar
4、diology,TheSecondAffiliatedHospitalofDalianMedicalUniversity,Dalian(116027)，LiaoningAbstractObjective:Toevaluateefectandsaltyofprimarypercutaneouscoronaryintervention(PCI)versusreduced-dosert-PAthrombolysiswithrescuePCIonlatelyleftventricularfunctiona
5、ndremodeling.Methods:Thepatientswithfirstacutemyocardialinfarctionwithin6hrsfromtheonsetofsymptomsandwithoutcontraindictiontothrombolytictherapywererandomlyassignedtoprimary-PCIgrouporrt-PAthrombolytictherapywithrescuePCIgroup.Two-dimensionalechocardi
6、ographywereappliedinthe3d,30d,90dafterAMIandmajorcardiaceventswererecorded.Results:Sixty-threepatientswereenroledandrandomlydividedintotwogroups,primary-PCI(groupA,32)，thrombolytictherapywithrescue-PCIgroup(groupB,31).Allpatientsweredividedintotwogrou
7、psaccordingtoTIMI-3ornotinfirsttimeangiography.Thediferencesofend-systolicvolumeindex(ESVI)，end-diastolicvolumeindex(EDVI)，leftventricularejectfraction(EF)andwalmotionscoresindex(WMSI)wereinsignificantstatisticalybetweenAandB(p>0.05,respectively)in3d,
8、30d,90dafterAMI.ThediferencesofESVI,EDVI,LVEF,WMSI*，significantstatisticallybetween30d,90dand3dineverygroup(p<0.05,respective-ly).ThediferencesofESVI,EDVI,EF,WMSIweresignificantstatisticalybetweenTIMI-3groupandothergroupsin30d,90daf-terAMI.Con
