急性心肌梗塞再灌注治療(6)
原發(fā)性支架置入術由于術后最小管腔直徑更大,早期及晚期缺血復發(fā)率低,并且隨訪時靶血管重建率低,因而可產(chǎn)生更好的效果。
小結
AMI再灌注治療顯著降低病死率并改善幸存者心功能,在各種再灌注治療方法中,溶栓治療應用最為廣泛,我國目前仍為首選。急診PTCA和原發(fā)支架置入在有條件的單位可作為溶栓的替代治療。如果成功率能達到臨床試驗的高水平則原發(fā)性支架置入術的療效優(yōu)于單純球囊擴張術,而后者又優(yōu)于溶栓治療。當然治療方法的選擇必須根據(jù)患者的病情及醫(yī)務人員技術水平和設備條件綜合考慮。直接PTCA和原發(fā)性支架置入術應由熟練掌握介入治療技術、在條件較好、人員配合默契的導管室進行,并應能在AMI就診60-90分鐘以內(nèi)開始PTCA,否則,治療的重點應放在早期溶栓治療。
參考文獻
1.The GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase or both on coronary artery patency, ventricular function and survival after acute myocardial infarction. N Eugl J Med 1993,329:1615-1622.
2.Chesebro J H, Knafferud G, Roberts R, et al. Thrombolysis in myocardial infarction (TIMI)Trial, phase 1:a comparison between intravenous tissue plasminagen activator and intravenous streptohinase: clinical findings through hospital discharge circulation 1987, 76:142-154.
3.The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. New Fngl J Med 1993, 329:673-682.
4.Ross AM. New plasminegen activators: a clinical review. Clin cardiol 1999, 22:165-171.
5.國產(chǎn)重組鏈激酶III期臨床試驗協(xié)作組,重組鏈激酶治療急性心肌梗塞的療效及安全性.中華心血管病雜志1999,27:180-183.
6."八五"國家攻關課題研究組. 急性心肌梗塞尿激酶應用研究:1138例. 中華心血管病雜志1996,24:169-173.
7.胡大一. 國產(chǎn)尿激酶治療急性心肌梗塞多中心臨床階段總結報告. 中國介入心臟病學雜志1995,3:145-147.
8.重組組織型纖溶酶原激活劑與尿激酶對比研究組. 國人小劑量重重組組織型纖溶酶原激活劑與尿激酶治療急性心肌梗塞隨機對照研究. 中華心血管病雜志1999,27:174-179.
9.Neuhaus KL, Tebbe U, Gotwik M, et al. Intravenous recombinant tissue plasminogen activator (rt-PA) and urokinase in acute myocardial infarction: results of German Activator Urokinase Study (GAUS). J Am Coll Cardiol 1988, 12:581-587.
10.TEAM-2 Study Investigators. Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. Circulation 1999,83:126-140.
11.Bar FW, Meyer J, Vermeer F, et al. Comparison of saruplase and alteplase in acute myocardial infarction. Am J Cardiol 1997,79:727-732., 百拇醫(yī)藥(高潤霖)
小結
AMI再灌注治療顯著降低病死率并改善幸存者心功能,在各種再灌注治療方法中,溶栓治療應用最為廣泛,我國目前仍為首選。急診PTCA和原發(fā)支架置入在有條件的單位可作為溶栓的替代治療。如果成功率能達到臨床試驗的高水平則原發(fā)性支架置入術的療效優(yōu)于單純球囊擴張術,而后者又優(yōu)于溶栓治療。當然治療方法的選擇必須根據(jù)患者的病情及醫(yī)務人員技術水平和設備條件綜合考慮。直接PTCA和原發(fā)性支架置入術應由熟練掌握介入治療技術、在條件較好、人員配合默契的導管室進行,并應能在AMI就診60-90分鐘以內(nèi)開始PTCA,否則,治療的重點應放在早期溶栓治療。
參考文獻
1.The GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase or both on coronary artery patency, ventricular function and survival after acute myocardial infarction. N Eugl J Med 1993,329:1615-1622.
2.Chesebro J H, Knafferud G, Roberts R, et al. Thrombolysis in myocardial infarction (TIMI)Trial, phase 1:a comparison between intravenous tissue plasminagen activator and intravenous streptohinase: clinical findings through hospital discharge circulation 1987, 76:142-154.
3.The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. New Fngl J Med 1993, 329:673-682.
4.Ross AM. New plasminegen activators: a clinical review. Clin cardiol 1999, 22:165-171.
5.國產(chǎn)重組鏈激酶III期臨床試驗協(xié)作組,重組鏈激酶治療急性心肌梗塞的療效及安全性.中華心血管病雜志1999,27:180-183.
6."八五"國家攻關課題研究組. 急性心肌梗塞尿激酶應用研究:1138例. 中華心血管病雜志1996,24:169-173.
7.胡大一. 國產(chǎn)尿激酶治療急性心肌梗塞多中心臨床階段總結報告. 中國介入心臟病學雜志1995,3:145-147.
8.重組組織型纖溶酶原激活劑與尿激酶對比研究組. 國人小劑量重重組組織型纖溶酶原激活劑與尿激酶治療急性心肌梗塞隨機對照研究. 中華心血管病雜志1999,27:174-179.
9.Neuhaus KL, Tebbe U, Gotwik M, et al. Intravenous recombinant tissue plasminogen activator (rt-PA) and urokinase in acute myocardial infarction: results of German Activator Urokinase Study (GAUS). J Am Coll Cardiol 1988, 12:581-587.
10.TEAM-2 Study Investigators. Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. Circulation 1999,83:126-140.
11.Bar FW, Meyer J, Vermeer F, et al. Comparison of saruplase and alteplase in acute myocardial infarction. Am J Cardiol 1997,79:727-732., 百拇醫(yī)藥(高潤霖)
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