冠状动脉内支架术治疗急性心肌梗死并发心源性休克的临床评价

Assessment of intracoronary stenting in acute myocardial infarction complicated by cardiac shock

目的 观察急性心肌梗死并发心源性休克的状态下 ,紧急冠状动脉内支架术对挽救患者生命的疗效及安全性。方法 急性前壁心肌梗死患者 15例 ,平均年龄 (70 1± 8 4)岁 ,动脉血压 <85 / 6 0mmHg(1mmHg=0 133kPa) ,心动超声检查射血分数 (EF) <42 % ,伴有明确的急性泵衰竭征象。患者发病 2 4h内紧急行左前降支冠状动脉支架术 ,其中 4例同时行右冠状动脉内支架术 ,3例行回旋支冠状动脉内支架术。介入治疗术前及术后观察血压、心率 ,应用心动超声测定心功能变化情况。结果 15例患者支架术后完全阻塞的左前降支血管再通良好 ,术后 30min血压与术前比较明显升高[收缩压 (10 6 0± 11 8)vs (76 2± 4 9)mmHg ,P <0 0 1;舒张压 (82 4± 9 7)vs (5 6 2± 6 1)mmHg ,P<0 0 1];心率明显下降 [(79 2± 8 4)vs (10 9 2± 9 1)次 /分 ,P <0 0 1]。术后 4h ,心动超声测定心功能明显改善 [EF(48 8± 4 7) %vs (34 3± 4 5 ) % ,P <0 0 1]。结论 急性心肌梗死并发心源性休克状态时 ,尤其是年老患者 ,治疗的关键是尽早使完全阻塞的血管再通 ,而冠状动脉内支架术是十分有效和较安全的治疗方法。

Objective To observe the effect and safety of emergent intracoronary stenting in acute myocardial infarction (AMI) complicated by acute pump failure.Methods Fifteen patients with anterier wall AMI and apparent signs of cardiac shock were (70.1±8.4) years old on average. Their mean blood pressures were less than 85/60 mm?Hg and the ejection fractions (EF) were less than 42% on echocardiography. All the cases were performed in plantation of stenting in left anterior discending branch (LAD), among which, 4 were in right anterior artery (RCA) and 3 in left circumflex (LCX). Before and after stenting, the changes of the patients′ blood pressures, heart rates and cardiac functions tested by ultrasonography were observed. Results In 15 patients, whose LADs were completely occlusive, after stenting, the coronary arteries gained perfect reperfusion. Compared before and after stenting, the blood pressures were increased significantly after stenting [SBP (106±11.8) vs (76.2±4.9)mm?Hg, P<0.01; DBP (82.4±9.7) vs (56.2±6.1)mm?Hg,P<0.01], the heart rates decreased [(79.2±8.4) vs (109.2±9.1)times/min,P<0.01]. Four hours after stenting, the candiac function was significantly better than before [EF (48.8±4.7)% vs (34.3±4.5)%,P<0.01].Conclusion When patients, especially the older ones, suffer AMI complicated by cardiac shock, the key to the therapy is to make the occlusive coronary arteries gain reperfusion as soon as possible while intracoronary stenting is a very effective and safe therapy.