溶栓成功后的

前面提过，溶栓成功后普遍存在严重残余狭窄。溶栓后再梗死既增加了死亡率又难以预测，评价溶栓成功后数小时到数天接受球囊血管成形术的早期试验，没有发现再梗死、左心室功能和生存率的改善。溶栓成功后接受PCI可以减少有自发和诱发心肌缺血的患者再梗死的风险。因此指南推荐，溶栓成功后患者再发心肌梗死、诱发心肌缺血或休克，或心力衰竭、左心室射血分数＜0．40，或有严重心律失常，可以行PCI。

但是，PCI技术的发展促使考虑常规实施溶栓成功后的PCI。多项随机试验认为，随着支架和GPⅡb／Ⅲa受体抑制药的应用，溶栓后6～24h行PCI可以降低1～2年再梗死、再次血供重建和死亡的风险。因此，现代PCI作为溶栓成功后的常规治疗可能是安全、有益的。

（王乐丰 杨新春 周 旭）

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