超声血管成形术治疗急性心肌梗死的安全性及近期疗效

Safety and short-term outcome of ultrasound angioplasty in treatment of acute myocardial infarction

目的 :评价经皮冠状动脉内超声血管成形术治疗急性心肌梗死 (AMI)的近期疗效及安全性 .方法 :通过导管技术对 2 8例急性心肌梗死患者的梗死相关血管血栓行血管内超声消融 ,比较超声消融前后梗死相关血管的狭窄程度、TIMI血流、静脉血中CK MB浓度、心电图ST段及临床症状的改变 ,计算消融后的校正TIMI帧数 .结果 :2 8例患者均有一支有大量血栓的IRA ,消融 (10 2 .2 6± 11.2 4 )s后IRA达TIMI 3级 2 7例 ,开通率为 96 .4 % (2 7 2 8) ,消融后IRA狭窄明显减轻 (0 .4 8± 0 .12vs 0 .88± 0 .0 9,P <0 .0 5 ) ,CTFC <2 3(15 .4± 3.7c s) 2 6例 .消融成功后 10min内患者胸痛消失 ,术后 (3.6 7± 0 .4 8)h血中CK MB浓度达到高峰 ,术后 6h抬高的ST段明显回落(0 .0 6 4± 0 .0 13mVvs0 .2 31± 0 .0 5 8mV ,P <0 .0 1) .2 8例患者消融术中及住院期间无死亡 ,无心源性休克、复发严重心肌缺血、再梗死等严重并发症 .结论 :低频高能超声血管成形术治疗AMI,可使IRA早期再通 ,恢复TIMI 3级血流和较好的远端心肌血流灌注 .

AIM: To evaluate the safety and short-term outcome of ultrasound angioplasty in treatment of acute myocardial infarction (AMI). METHODS: A total of 28 patients with AMI were treated by coronary ultrasound thrombolysis. The degree of stenosis was measured and analyzed with INNOVA 2000 computerized analyzing system and the changes in imaging and blood flow in IRA, CK-MB value, ST segment in ECG and clinical manifestations before and after the treatment were observed to evaluate the feasibility of angioplasty with ultrasound in treating AMI. CTFC was measured immediately after successful ultrasound thrombolysis (TIMI 3). RESULTS: At least one IRA with massive thrombosis was found in all the 28 patients. The repeated angiography at the end of ultrasound thrombolysis showed no image of thrombi again and IRA achieved grade III of TIMI blood flow in 27 out of the 28 patients with AMI (potency-recovering rate=96.4%). The stenosis decreased significantly after the operation(0.48±0.12 vs 0.88± 0.09,P<0.05) and CTFC was less than 23 count/second (mean 15.4±3.7 count/second) in 26 patients. Disappearance of chest pain, remarkable decrease in ST segment(0.064±0.013 mV vs 0.231±0.058 mV, P<0.01) and obvious migrating forward of CK-MB peak value were found in 27 patients. There were no adverse clinical events during the procedure and hospitalization. CONCLUSION: Percutaneous transluminal coronary ultrasound thrombolysis can be used as a new approach to treat acute myocardial infarction, for it can open IRA as early as possible, restore grade-III TIMI blood flow and improve distal coronary reperfusion.