冠状动脉介入治疗急性心肌梗死(摘要)

Intervention therapy in acute myocardial infarction(Summary)

目的 :观察冠状动脉介入治疗急性心肌梗死的安全性 ,疗效和并发症。方法 :2 0 0 1年 12月 1日至 2 0 0 2年7月 3 1日对 2 4例急性心肌梗死患者在发病 12小时内行冠状动脉介入治疗。男 2 0例 ,女 4例。年龄 48-81岁 (65± 8)。 14例直接行冠脉腔内成行术 (PTCA)和支架术 ,7例系静脉溶栓失败后行PTCA和支架术 ,3例冠脉造影发现不适合行PTCA和支架术而行冠脉内溶栓。 2 4例中有 1例心肺复苏后及 2例心源性休克患者。梗死相关血管 :左前降支 (LAD) 15例 ,旋支 (LCX) 2例 ,右冠脉 7例。TIMI血流 0级 17例 ,1级 7例。结果 :2 4例中 2 1例PTCA后植入支架 2 3枚 ,TIMI血流均达到 3级 ,其中有 2例支架植入时TIMI血流 2级经冠脉内注射异搏定 2 0 0微克及尿激酶(UK) 2 5万单位后达到 3级。发病到梗死相关血管再灌注时间为 2 -13小时 (5 .2± 1.2 )。有 1例用球囊扩张后发现有很多血拴不宜植入支架 ,有 1例进导引导丝时发现血栓向近端增长不宜继续PTCA及支架术 ,有 1例冠脉造影发现LAD起始 10 0 %堵塞与左主干之间无断端也不宜行PTCA和支架术 ,上述 3例均改为冠脉溶栓 ,7天后再造影相关血管均已再通。住院期间 2例心源性休克患者均死亡 ,1例死于PTCA和支架术后无再流 ,推测为远端血栓堵塞 ,1例死于顽固性心力衰竭 ,?

Objection: Analysis the safety, efficiency and complication of intervention therapy in acute myocardial infarction. Methods: 24pts are studied in total .They all accepted the coronary intervention between 2001.Dec.1st and 2002.Jul.31th .20 is male and 4 is female. The ages range from 48-81 years old. Among them 14pts have the primary coronary intervention (PTCA and stenting), while 7pts undergo the procedure after thrombolysis. 3pts' angiography shows no indication for PTCA or stenting, and have intracoronary thrombolysis treatment. In the 24pts, one is resuscitation, 2pts suffer from cardiogenic shock. The infarction-related artery are :15pts in LAD, 2pts in LCX, 7pts in RCA. And TIMI grade 0 in 17pts, TIMI grade 1 in 7pts. Results:23 stents are implanted after PTCA in 21pts, with the TIMI grade 3(2pts having TIMI grade 3 by intracoronary using verapamil 200ug and UK 25,000U.).The time between onset and reperfusion is 2-13 hours. There is no indication for stenting for much thrombus after balloon inflation in one patient, while for another patient, the reason for quit the procedure is thrombus increased toward proximal segment with the wire. And in 3rd case, there is 100% lesion in ostium of LAD without residue. All above noted cases undergo the intracoronary thrombolysis, and achieve the revascularization as for angiography 7 days later. Two patients with cardiogenic shock died in hospital, one for no-reflow after PTCA and stenting procedure (maybe the distal thrombus), another for refractory heart failure (maybe acute reocclusion after procedure).In follow-up period( 4-11months),no cardiac event happen in the survived 22pts. Conclusion: Coronary intervention AMI is superior for its safety and low complication. The main complication is slow reflow , no reflow and acute occlusion. To avoid these events, the operator should judge in time who is not amenable to PTCA or stenting, when prefer to thrombolysis. In this study , no complication happen after PTCA and stenting with pre operation intravenous thrombolysis . Whether using half-dose rt-PA or 150,000U UK/SK before PTCA and stenting would reduce the complication need more study.