基层医院急性心肌梗死新型治疗模式的初步研究

A preliminary study of a new modle to treat acute myocardial infarction in the county-class hospital

目的评估借助外埠心脏介入专家赶赴县级医院,就地急诊经皮冠状动脉介入治疗术(PCI)治疗急性心肌梗死(AMI)的安全性、可行性及有效性。方法2004年3月至2006年4月,我院共对21例AMI患者采用外请心脏介入专家,就地实施急诊PCI进行治疗。患者年龄40～83岁,平均72.6岁,男性16例,女性5例。前壁心肌梗死16例,下壁心肌梗死5例(其中1例并右室梗死)。起病3～12h,平均6.2h。结果21例患者中,除1例病变严重,转上级医院行冠脉搭桥外,对20例就地实施了急诊PCI,16例为直接PCI,4例为补救性PCI,梗塞相关动脉共置入支架21枚。其中1例因球囊不能通过病变而失败,故手术成功率95%。死亡1例,为广泛前壁心肌梗死伴早期心源性休克患者,虽对两处IRA成功置入支架,但患者术后因休克不能纠正而死亡。另有两例发生围手术期心肌梗死,经抢救均成活。平均随访(16±1)个月,PCI组共3人死亡(2人心原性死亡,1人非心源性死亡),剩余17例患者无心血管事件发生。结论县级医院采用外请专家就地行急诊PCI治疗AMI的方法安全、可行、有效。

Objective To evaluate the safety and feasibility of patients with AMI treated via direct percutaneous coronary intervention performed by specialists from center hospitals in the county-class hospital Methods 21 consecutive patients with AMI were enrolled in the study during Mar 2004 to Apr 2006. Of these Patients, 16 were men and 5 women with average age of 72.6（40-83 ）, 16 patients with anterior wall AMI and 5 with inferior wall AMI（ 1 complicated right ventricle AMI）. The average time from symptom onset to our hospital was 6.2 hours （3-12 hours）. Results All of the patients except one transfered to the center hospital to CABG because of the lesion unsuitable to PCI were performed emergency PCI by invited specialist in the spot. Of these 20 patients, 16 were direct PCI, 4 were rescue PCI. 21 stents were implanted in the IRAs. One patient was failure because balloon could not pass the lesion, thus the procedure success rate was 95%. One patient died from cardiac shock though two stents were successful implanted in the two infarction related arteries（ 1 in LAD and 1 in RCA）. Two pa- tients experienced reinfarction within 24 hours after PCI, both were alive under proper management. Three patients died, one was due to stroke, the other two were cardiac cause, the rest patients hove had no cardiac events during 16±1 months follow-up in average. Conclusion The model of inviting specialist emergency to perform direct PCI in patiets with AMI in county-class hospital is safe and feasible. Further large scale clinical studies are needed.