急性心肌梗死急诊PTCA及支架植入的临床观察

Emergency PTCA and brace implantation in acute myocardial infarction

目的 观察急性心肌梗死急诊PTCA及冠脉内支架植入的临床效果及安全性。方法 对73例急性心肌梗死相关血管行直接PTCA50例,立即FICA15例,挽救FTCA8例,放置支架20枚。结果 总血管开通率94.5％(69/73);TIMI血流在20例放置支架血管均为Ⅲ级,在49例单纯PTCA血管中44例为Ⅲ级,5例为Ⅱ级;残余狭窄在放置支架的血管为(1.8±5.9)％(-10％～10％),在单纯PTCA血管为(15.4±11.2)％(0～30％);再通性心律失常发生率18.1％(10/62),在左前降支主要为频发室早和短阵室速,在右冠状动脉主要为心动过缓和不同程度的房室传导阻滞。结论急诊PTCA和放置支架可明显提高急性心肌梗死相关血管的再通率,有必要在有条件的医疗单位推广应用。

Objective To further improve the rate of reperfusion of infarction related artery in AMI, remove the stricture, rescue ischemic myocardium, protect cardiac function and ameliorate the long-term prognosis. Method Among 73 patients with AMI, 50 underwent direct PTCA, 15 immediate PTCA, 8 rescue PTCA and 20 braces were implanted. Result The proportion of recanalization is 94.5% (69/73). The grade of blood flow (TIM) improved to grade 3 in 20 patients with brace implantion, while 44 to grade 3 and 5 to grade 2 among 49 patients with simple PTCA. Residual stenosis in vessel was (1.8±5.9)%( - 10% - 10%) in patients with brace implantation versus (15.4±11.2)% (0-30%) with simple PTCA. The incidence of reperfusive cardial arrythmia was 18.1%(10/ 62). There was mainly frequent ventricular premature beat and short paroxymal ventricular tachycardia, if left anterior decending branch was reopened, while bradycardia and a-trial ventricular block usually occurred after right coronary reperfused. Conclusion Emergency PTCA and brace implantation can apparently improve the proportion of reperfusion of IRA in AMI. It is necessary to popularize and apply these treatment in medical units with available conditions.