过时间窗的急性心肌梗死患者血栓自溶的影像学观察及探讨

Studying the iconography characteristics of the spontaneous recanalization in patients with MI over thrombolysis time window

目的研究超过溶栓时间窗的心肌梗死患者血栓自溶现象及其最佳治疗方法。方法符合S-T段抬高的急性心肌梗死的诊断标准。心肌梗死发作时间>24h,<72h的患者38例。无休克症状。做两次冠脉造影,并行影象学及TIMI分级评价。结果第1次冠脉造影观察的38例患者均有1支或2支冠脉血管完全阻断,TIMI血流0级。其中右冠脉堵塞15例,左冠脉前降支19例,回旋支堵塞2例,右冠脉和前降支均堵塞2例。10d后第2次冠脉造影28例,观察血栓自溶完全再通者15例,TIMI血流2～3级;血栓自溶现象的发生率为39%。结论>24h,<72h的心肌梗死患者血栓自溶现象仍有存在,若无溶栓禁忌,溶栓治疗可使血管早日再通,使心肌细胞凋亡数减少。

Objective Studying with coronary angiography the iconography characteristics of the spontaneous recanali- zation in 38 patients after MI over thrombolysis time window and treating. Methods According to diagnostic criteria of MI of S- T segment elevation, the patients with MI within 〉24,〈72 hours, no shock,having twice coronary angiography;estimating TIMI flow and the morphological characteristics. Results First coronary angiography of 38 cases record ： one or two coronary artery blockage, TIMI 0 flow; right coronary artery blockage 15, anterior descending branch 19, circumflex branch 2, double blood ves- sels 2. coronary angiography of 28 eases reeord after 10 days：spontaneous recanalization of the infarct-related lesion in 15 pa- tients, TIMI 2 - 3 flow,incidence of thrombus spontaneous recanalization was 39%. Conclusion spontaneous recanalization of myocardial infarction still to remain within 〉24, 〈72 hours. If no contraindications, thrombolysis may make crime vessels recanal- ization early and decrease myocardial cell apoptosis.