急性心肌梗塞恢复期的冠状动脉内支架置入术

Intracoronary stent placement in the recovery period after acute myocardial infarction

１６例急性心肌梗（ＡＭＩ）患者发病后恢复期（２～４周）行及冠状动脉内支架术治疗。分为两组，梗塞后心绞痛组６例，梗塞后心功能不全组１０例。经冠脉造影证实其梗塞相关冠状动脉均处于完全闭塞及次全闭塞状态。１５例为单支，１例为双支。术前平均狭窄度（９２．５±５．１）％，平均狭窄长度（１９．５±５．３）ｍｍ。共植入１９枚支架。手术成功率１００％，１例术后３天发生亚急性血栓形成。术后造影显示平均狭窄度为０～１０％，梗塞后心绞痛组临床症状消失，梗塞后心功能不全组的超声心动图提示左房内径（３６．８±３．４）ｍｍ，左室内径（５５．１０±３．７３）ｍｍ，左室射血分数０．６１±０．０８，优于术前的左房内径（３９．４０±４．１２）ｍｍ，左室内径（５９．６０±５．２５）ｍｍ，左室射血分数０．５２±０．１０。随访１～２０个月无１例死亡，无再梗塞，心功能均在Ⅰ～Ⅱ级。本文说明ＡＭＩ恢复期冠脉再通是增加冠脉血流，维持正常心功能和降低死亡率的一个有效方法。

Angiography and intracoronary stent was performed in 16 patients during the recovery period after acute myocardial infarction in our hospital from November 1995 to October 1997The group comprised 16 men,mean age being 527118 yearsSix had postinfarction angina,and ten had postinfarction heart failureThe infartrelated vessel was single in 15 cases,8 in LAD,5 in RCA,2 in LCX,and infartrelated vessel was double in 1 case,LAD+RCAMean Lesion length was 19553 mm and average diameter stenosis before procedure was 92551%Nineteen intracoronary stents were implanted,10 in LAD,7 in RCA,2 in LCXThree patients received 2 stentsThe procedure success rate was 100%After the stents implanting,average diameter stenosis decreased to 010%,postinfarct angina disappearedIn the postinfart heart failure group,the diameter of left atriun and left vertricular by the UCG were reduced,enjection fraction increased significantlyOur results indicate that intracoronary stent during the recovery period after myocardial infarction pr