冠状动脉内超声溶栓治疗急性前壁心肌梗死的临床观察

Clinical observation of coronary ultrasound thrombolysis in acute anterior myocardial infarction

目的 研究超声溶栓溶解急性前壁心肌梗死 (AMI)梗死相关血管 (IRA)血栓的疗效。方法 入选急性前壁心肌梗死患者 32例 ,左前降支近段闭塞 2 2例 ,中段闭塞 10例。超声溶栓后IRA均行急诊PTCA。结果 超声溶栓后 2 2例IRA达TIMI3级 ,成功率为 70 % ,左前降支近段 17例 (成功率 78% ) ,中段 5例 (成功率 5 0 % )。超声溶栓成功者术后残余狭窄为 (6 5± 13% )。急诊PTCA10 0 %成功 ,残余狭窄减少至 (2 3± 17) %。超声溶栓时 ,胸痛 2例 ,耳鸣 1例。导丝与超声探头卡住而不能拔出 2例。结论 低频、高能超声波可有效溶解IRA内的血栓 ,可安全用于AMI患者 。

objective:The study was conducted to obtain preliminary experience of coronary ultrasound thrombolysis(CUT)in acute anterior myocardial infarction(AMI).Methods:Consecutive patients(n=32) with evidence of anterior AMI underwent CUT.All patients had the occlusion in LAD(proximal 22,middle 10).Thrombolysis in myocardial infarction(TIMI)grade 0 or 1 flow in the infarct related arteries(IRA) were confirmed.PTCA were performed in all patients after CUT.Results:Ultrasound induced successful reperfusion in 70% of the patients and produced a residual stenosis of (65±13)%.PTCA were successful in all patients and had residual stenosis of (23±17)% as determined by coronary angiographic analysis.During CUT,2 patients complainet of chest pain and one complained of tinnitus.The guidewire were fasted with guidewire was caught in the probe in 2 patients.Conclusion:Our prelinunary study suggested that low frequency high energy coronary ultrasound thrombolysis could lyze the thrombus in patients with Acute Anterior MI.It can be applied in selected patients.