急性心肌梗死伴心源性休克的治疗

Clinical Outcomes of Acute PCI in AMI Patients Accompanying Cardiogenic Shock

目的 探讨急性心肌梗死伴心源性休克的临床处理方法,分析其疗效,寻求降低死亡率、改善预后的措施。 方法 回顾性地分析1996年2月～1999年12月共48例急性心梗伴心源性休克患者接受急诊介入治疗的效果。 结果 48例患者均在主动脉内球囊反搏(IABP)支持下行急诊冠脉造影,其中46例成功地进行介入治疗,2例因介入治疗未成功而搭桥,14例虽罪犯血管成功介入治疗,但因血流动力学仍不稳定而行搭桥治疗获成功。单纯介入治疗死亡率25％,外科搭桥死亡率0％,总死亡率16.7％。 结论 IABP支持下行急诊冠脉介入治疗,可显著提高急性心肌梗死伴心源性休克患者的生存率,介入失败和多支病变经介入治疗后血流动力学仍不稳定者,应及时进行外科搭桥治疗。

Objective To assess the clinical outcomes of acute percutaneous coronary intervention ( PCI ) in patients with cardiogenic shock accompanying acute myocardial infarction ( AMI ). Methods A retrospective analysis of 48 AMI patients with cardiogenic shock treated with PCI during Feb, 1996 ~ Dec, 1999 was carried out. Results The PCI success rate was 95.8% (46/48) and the overall in -hospital mortality rate was 16.7% (8/48). 33.3% (16/48) patients required urgent cononary artery bypass (CAB) and may with a 0% mortality rate. Conclusion Urgent PCI is safe and feasible significantly decrease mortality. The prognosis is bad in patients with the left main or multivascular disease who may be rescued by CABG in time.