不同溶栓时间窗溶栓治疗ST段抬高型心肌梗死临床疗效的对比研究

摘要

Objective To compare the clinical effect on ST-segment elevation myocardial infarction in different time-window thrombolytic therapy.Methods From July 2013 to June 2016,a total of 148 ST-segment elevation myocardial infarction patients undergoing thrombolytic therapy were selected in the Department of Cardiology,the People′s Hospital of Jianli County,Jingzhou,and they were divided into A group and B group,each of 74 cases.Patients of A group received reteplase for thrombolytic therapy within 6 hours after onset,while patients of B group received reteplase for thrombolytic therapy within 6 to 12 hours after onset.Recanalization time,ST-segment fall back ratio after 2,4,6 and 12 hours of thrombolytic therapy,serum NT-proBNP level immediately after thrombolytic therapy,after 12 hours,1 day,3 days and 7 days of thrombolytic therapy,LVEF,LVESD and LVEDD immediately after thrombolytic therapy,after 7 days,3 months,6 months and 12 months of thrombolytic therapy were compared between the two groups,and incidence of adverse cardiac events was observed during the treatment.Results Recanalization time of A group was statistically significantly shorter than that of B group(P<0.05);ST-segment fall back ratio of A group was statistically significantly higher than that of B group after 2,4,6 and 12 hours of thrombolytic therapy,respectively(P<0.05).No statistically significant differences of serum NT-proBNP level was found between the two groups immediately after thrombolytic therapy(P>0.05),while serum NT-proBNP level of A group was statistically significantly lower than that of B group after 12 hours,1 day,3 days and 7 days of thrombolytic therapy,respectively(P<0.05).No statistically significant differences of LVEF,LVESD or LVEDD was found between the two groups immediately after thrombolytic therapy or after 7 days of thrombolytic therapy(P>0.05);after 3 months,6 months and 12 months of thrombolytic therapy,LVEF of A group was statistically significantly higher than that of B group,respectively,while LVESD and LVEDD of A group were statistically significantly shorter than those of B group(P<0.05).Incidence of adverse cardiac events of A group was statistically significantly lower than that of B group during the treatment(P<0.05).Conclusion Thrombolytic therapy within 6 hours after onset has better clinical effect in treating ST-segment elevation myocardial infarction than thrombolytic therapy within 6 to 12 hours after onset,can more effectively improve the cardiac function and inhibit the ventricular remodeling,with higher safety.%目的 比较不同溶栓时间窗溶栓治疗ST段抬高型心肌梗死(STEMI)的临床疗效.方法 选取2013年7月-2016年6月在荆州市监利县人民医院心内科接受溶栓治疗的STEMI患者148例,采用随机数字表法分为早期组和晚期组,每组74例.早期组患者于发病6 h内给予瑞替普酶溶栓治疗,晚期组患者于发病6~12 h内给予瑞替普酶溶栓治疗.比较两组患者血管再通时间,溶栓后2 h、4 h、6 h及12 h ST段回落率,溶栓后即刻、12 h、1 d、3 d及7 d血清氨基末端脑钠肽前体(NT-proBNP)水平,溶栓后即刻、7 d、3个月、半年及1年左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD);并观察治疗期间两组患者心脏不良事件发生情况.结果 早期组患者血管再通时间短于晚期组,差异有统计学意义(P<0.05);溶栓后2 h、4 h、6 h及12 h早期组患者ST段回落率高于晚期组(P<0.05).溶栓后即刻两组患者血清NT-proBNP水平比较,差异无统计学意义(P>0.05);溶栓后12 h、1 d、3 d及7 d早期组患者血清NT-proBNP水平低于晚期组(P<0.05).溶栓后即刻、7 d两组患者LVEF、LVESD、LVEDD比较,差异无统计学意义(P>0.05);溶栓后3个月、半年、1年早期组患者LVEF高于晚期组,LVESD和LVEDD短于晚期组(P<0.05).治疗期间早期组患者心脏不良事件发生率低于晚期组(P<0.05).结论 发病6 h内溶栓治疗STEMI的临床疗效优于发病6~12 h溶栓治疗,其能更有效地改善患者心功能、抑制心室重塑,且安全性较高.