再灌注损伤在急性心肌梗死合并低血压及心源性休克中的临床意义和治疗对策

Clinical significance and treatment of reperfusion injury in acute myocardial infarction patients with hypotension and cardiogenic shock

目的探讨再灌注损伤在急性心肌梗死(AMI)合并低血压状态(简称低血压)及心源性休克(CS)中的临床意义和治疗对策。方法观察AMI合并低血压及CS行急诊经皮冠状动脉介入治疗(PCI)患者131例,术中再灌注后出现或加重低血压及CS为治疗组(45例),其他为对照组(86例),观察两组再灌注损伤的临床表现及应用优化升压药配合主动脉内球囊反搏术(IABP)的序贯疗法支持下急诊PCI的疗效。结果术中再灌注后出现或加重的低血压及CS 45例(占34.35%,治疗组),对照组86例(占65.65%),两组发生再灌注心律失常共100例(76.34%),包括加速性室性自主心律43例,窦性心动过缓31例,室性早搏23例,室颤3例。治疗组病死率和心血管事件(左心心力衰竭)与对照组比较差异无统计学意义,但需要使用IABP的患者明显减少(P<0.05)。结论再灌注损伤是AMI合并低血压及CS的重要原因之一,再灌注损伤导致的低血压和CS,用优化升压药配合IABP的序贯疗法配合急诊PCI是一种快捷、实用、安全的治疗方法。

Objective To explore the clinical significance and treatment of reperfusion injury in acute myocar-dial infarction （AMI）with hypotension and cardiogenic shock.Methods One hundred and thirty -one AMI patients with hypotension and cardiogenic shock who were undergoing emergency PCI were collected.According to the occurring or worsening of hypotension and cardiogenic shock after reperfusion,45 patients were divided into treatment group,and the other 86 patients were divided into control group.To analyze the clinical manifestations of myocardial ischemia reper-fusion injury and the efficacy of emergency PCI supported by sequential therapy with optimized vasopressors and IABP in both groups.Results After reperfusion,45 patients （34.35% ）were occurred or worsen of hypotension and cardiogen-ic shock as treatment group;86 patients （65.65%）as control group.There were 100 cases of reperfusion arrhythmia （76.34%）in both groups,including 43 cases of accelerated idioventricular rhythm,31 cases of bradyarrhythmia,23 ca-ses of premature ventricular contraction,and 3 cases of ventricular fibrillation.The fatality rate and cardiovascular event （such as left ventricular failure）rate were no statistically significant difference between the treatment group and the con-trol group.However,the number of patients that must use IABP of treatment group was significantly lower than control group （P 〈0.05）.Conclusion Reperfusion injury is one of the leading causes of AMI with hypotension and cardiogen-ic shock.It can be treated with emergency PCI supported by sequential therapy with optimized vasopressors and IABP.