急性心肌梗死伴心源性休克的病死率研究

Mobidity and mortality analysis of acute myocardial infarction with cardiogenic shock

目的观察<6h的早期心肌梗死(AMI)冠状动脉再通及其他辅助治疗对急性AMI伴心源性休克患者转归的影响,探讨最佳治疗方案。方法对前壁AMI伴心源性休克的30例患者进行回顾性研究。结果 30例患者均接受溶栓治疗,溶栓后分为药物组(14例)和介入组(16例)。药物组家属拒绝介入治疗,给予血管活性药物;介入组行冠脉造影术、行经皮冠状动脉腔内成形术、支架术、主动脉内球囊反搏、呼吸机辅助呼吸等治疗。药物组患者住院期间死亡11例,病死率为78.6%。介入组死亡5例,病死率为31.3%,较药物组明显降低(P<0.01)。结论溶栓后早期冠状动脉再通可降低急性心肌梗死伴心源性休克的病死率。

Objective To evaluate the effect of early coronary revascularization （AMI 6 h） and other ancillary therapies for acute myocardial infarction （AMI） with cardiogenic shock, and explore the best treatment options and minimize mortality. Methods Thirty consecutive patients with AMI complicated with cardiogenic shock were studied retrospectively. Patients with ventricular septal perforation were excluded. All patients received thrombolytic therapy. Fourteen patients were treated with medications only. The interventional group （n =16） received coronary angiography, percutaneous transluminal coronary angioplasty （PTCA）, coronary stent implantation, intra -aortic balloon pump （IABP）, and mechanical ventilation. The in-hospital mortality rate of the medication treatment group and the interventional group was compared. Results Eleven patients in the medication group died, the mortality rate was 78.6%. Five patients in the interventional group died, the mortality rate was 31.3% . The mortality rate of the interventional group was significantly lower （P 0.01）. Conclusion The early successful PCI after thrombolytic therapy can decrease the mortality rate of AMI with cardiogenic shock.