急性心肌梗塞急诊介入治疗

Emergent Use of Introcoronary Stenting in Acute Myocardial Infarction

目的 :评价急性心肌梗塞急诊冠状动脉腔内成形术 (PTCA)和支架置入术的疗效。方法 :随机选择 1998年 4月至 2 0 0 2年 5月因急性心肌梗塞 (AMI)在本院行急诊PTCA和支架置入术治疗的患者 5 4例 ,其中 5例行单纯PT CA ,4 6例行PTCA +支架治疗。 5 1例中 12例因PTCA后靶血管内有大量血栓形成 ,植入支架前行冠脉内尿激酶溶栓。 3例行冠脉内溶栓。结果 :5 4例患者 ,手术成功 5 1例 ,成功率 94 .4 % ,共置入支架 5 2枚 ,4 7例术中IRA血流达TIMI3级 ,4例术中IRA血流TIMI2级 ,2 4h后血流达TIMI3级。 3例手术失败 ,原因为指引导丝不能通过靶病变、指引导管支撑不佳、无相应手术器械 ;手术成功患者 2例术后死亡 ,其中 1例死于感染性休克 ;1例死于术后急性冠脉闭塞 ,泵衰竭。结论 :急诊PTCA和支架植入 ,能尽快、及时有效地开通IRA ,挽救濒死心肌 ,改善预后 ;尤对AMI合并心源性休克患者 ,不仅能明显降低死亡率 ,挽救生命 ,而且成功率高 ,疗效显著 ,恢复快 ,可作为AMI首选治疗方法。

Objective:To evaluate the efficacy and safety of emergent stenting in acute myocardial infarction(AMI).Methods:There were 54 patients with AMI were treated with emergent coronary angioplasty(PTCA) and stenting from April 1998 to May 2002.Forty six patients were treated with primary PTCA and five with rescue PTCA because of fail thrombelysis.During procedure,12 patients were given introcoronary thrombolytic therapy before stenting because there were plenty of thrombosis in the IRA. Beside IRA, the other diseased coronary were treated with PTCA and stenting among 5 patients.Results:Fifty one patients were operated on successfully(94.4%),52 were placed on lesion.IRA of 47 patients obtained TIMI 3 flow, IRA of 4 obtained TIMI 2 flow,3 did fail operation because wire couldnˊt cross the lesion or guiding cather had not gain suitable sustain;2 died after operation. One died of infective shock and multiple organ failure and the other died of acute coronary occlusion and cardiogenic shock.Conclusion:Emergent use of PTCA and stenting could rapidly and efficaciously represses IRA, rescue dying cardiomy, improve prognosis; It has specific role in patients with AMI complicated by cardiogenic shock that emergent stenting can not only obviously reduce,but also have high successful rate and notable effect.