老年急性心肌梗死急诊介入治疗的临床效果

Clinical efficacy of emergency coronary angioplasty in elderly patients with acute myocardial infarction

目的 探讨老年急性心肌梗死 (AMI)患者行急诊经皮冠状动脉介入治疗 (PCI)的临床效果。方法 6 6例患者 ,年龄 6 0～ 88(6 8.3± 10 .2 )岁 ,其中 >75岁 18例 ;男 5 7例 ,女 9例。患者入院后经临床和心电图诊断 ,AMI诊断按 1979年 WHO提出的 AMI诊断标准。结果 6 2例患者接受直接 PCI术 ,4例接受补救性 PCI。梗死相关血管 :前降支 2 4支 ,回旋支 11支 ,右冠状动脉 2 1支。有 6 3例患者的病变血管置入进口或国产支架 73枚 ,3例行经皮腔内冠状动脉成形术 (PTCA) ,残余狭窄 0～ 2 0 % ;开通后 6 0例患者血流达 TIMI 3级 ,5例患者 TIMI血流 级 ,1例患者血流 TIMI 0级。并发症与随访 :2例术后 4 8h内心源性休克死亡。对出院的 5 2例患者平均随访 (2 6 .1±13.3)月 (从 1个月至 78个月 ) ,再发急性心肌梗死 2例 ,心绞痛 4例 ,猝死 1例。结论 老年 AMI患者急诊介入性治疗可最大限度地恢复冠状动脉血流 ,手术成功率高 ,严重并发症少 ,是一种安全、有效的方法。尤其适应于高龄、有溶栓禁忌证或伴有心源性休克的患者。

Objective To evaluat the clinical efficacy of urgent percutaneous coronary intervention(PCI) on the elderly acute myocardial infarction(AMI) patients. Methods A total of 66 patients were identified for analysis: mean 68.3±10.2 years old(from 60 to 88 years), 57 men and 9 women, 18 patients over 75 years. All AMI patients were diagnosed by ECG as WHO diagnosis standard in 1979. Results Directly PTCA was performed on 62 patients and secondly on 4 patients after the treatment of dissolving thrombus were failed as observing for 90 minutes in hospitalizing. The distributes of infarction-elated arteries(IRA):24 for anterior descending branch, 11 for circumflex branch, 21 for right coronary artery. 73 stents(importation or home-made ) were implanted into 63 infarction-associated coronary vessels in 63 patients and the success rate were 100%, simplify PTCA was performed in 3 patients, remaining narrow rang 0～20%. The TIMI 3 for coronary circulation of 60 patients vs TIMI 2 for 5 patients, one patient no blood flowing. 2 patients died of cardiogenic shock after operation 24 hours. 52 discharged patients were follow up for (26.1±13.3) months(from 1 to 78 months),2 patients death occurred, 5 patients had chest pain again, 2 patients had AMI again. Conclusion The urgent percutaneous coronary intervention(PCI) on elderly AMI patients is an effective and safety method of restoring coronary circulation with few complications and high success rate of operation. It is special applicable to the patients who have heart source shock and contraindication of dissolving thrombus.