急性心肌梗死伴心源性休克的治疗

Treatment of Acute Myocardial Infarction With Cardiogenic Shock

目的：本文观察早期冠状动脉再通及其他辅助治疗对急性心肌梗死（ＡＭＩ）合并心源性休克患者转归的影响。方法：对ＡＭＩ伴心源性休克的１７例患者进行回顾性研究，除外１例合并心室间隔穿孔。其余１６例患者分为药物组５例，仅应用药物治疗；介入组１１例接受溶栓，行经皮冠状动脉腔内成形术、行支架术、主动脉内球囊反搏、呼吸机辅助呼吸等治疗。介入组患者经冠状动脉造影后根据心肌梗死溶栓试验（ＴＩＭＩ）分级进一步分为再通组与未再通组。对药物组和介入组，再通组和未再通组住院期间病死率进行了比较。结果：药物组患者住院期间全部死亡，病死率１００％。介入组患者４例死亡，病死率３６％，较药物组明显降低（Ｐ＜０．０１）。介入组患者经冠状动脉造影未再通组（ＴＩＭＩ０～Ⅰ级）４例，３例死亡，病死率７５％，再通组（ＴＩＭＩⅡ～Ⅲ级）７例，死亡１例，病死率１４％，与未再通组比较病死率显著降低（Ｐ＜０．０１）。结论：早期冠状动脉再通，同时应用主动脉内球囊反搏。

Objective:To evaluate the effect of early coronary revascularization and other additive therapies on acute myocardial infarction with cardiogenic shock. Methods:A consecutive 17 patients of acute myocardial infarction (AMI) complicated by cardiogenic shock were studied retrospectively.Eliminating one patient with ventricular septal perforation,16 patients were enrolled in our study.The drug group ( n =5) treated only with drugs.The interventional group ( n =11) received thrombolytic therapy,percutaneous transluminal coronary angioplasty (PTCA),coronary stent,intra aortic balloon pump (IABP),mechanical ventilation.After coronary angiography,the interventional group was further divided into successful revascularization group( n =7) and unsuccessful revascularization group ( n =4) according to thrombolysis in myocardial infarction trial (TIMI) grade of infarction related artery (IRA).The inhospital fatality rates of the drug and the interventional group as well as those of the successful and the unsuccessful revascularization group were compared. Results:No one in the drug group was survival,the fatality rate was 100%.Four patients died in the interventional group,the fatality rate was 36%.The fatality rate is lower in the interventional group( p <0.01).Among the 11 patients in the interventional group,7 patients were diagnosed as successful revascularization (the successful revascularization group,TIMI Ⅱ～Ⅲ degree),the other 4 patients were diagnosed as unsuccessful revasculation (the unsuccessful revascularization group,TIMI 0～Ⅰ degree) by coronary angiography.3 died in the unsuccessful revascularization group,the fatality rate was 75%.Only one died in the successful revascularization group,the fatality rate was 14%.The fatality rate is lower in the successful revascularization group( p <0.01). Conclusion:These data suggest that the early successful coronary revascularization and the use of other additive therapies will decrease the case fatality rate of AMI with cardiogenic shock.