急性心肌梗死直接冠状动脉内支架置入的临床评价  

Study of emergency direct coronary stenting in patients with acute myocardial infarction

作　　者：陈玉国[1] 徐峰[2] 张运[1] 李继福[1] 李贵双[1] 纪求尚[1] 刘同涛[1] 

机构地区：[1]山东大学齐鲁医院,山东济南250012 [2]山东大学医学院,山东济南250012

出　　处：《中国急救医学》2004年第9期640-642,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　探讨急诊直接冠脉内支架置入术治疗ST段抬高型急性心肌梗死 (AMI)的价值。方法　ST段抬高型AMI患者 133例 ,分别行直接冠脉内支架置入术 (直接支架组 ,81例 )和球囊预扩张后支架置入术 (常规支架组 ,5 2例 )。对比两组患者的介入治疗、术后TIMI分级和心电图、出院前左室射血分数 (LVEF)和住院期间主要不良心脏事件发生率。结果　直接支架组和常规支架组基础临床特征、TIMI 3级和无复流均无统计学显著差异 (P >0 .0 5 )。直接支架组平均X线曝光时间和造影剂用量均显著低于常规支架组 (P <0 .0 5 ) ,而平均LVEF显著高于常规支架组 (P <0 .0 5 ) ,且ST段无回落的发生率和住院期间主要不良心脏事件发生率均显著降低 (P <0 .0 5 )。结论　对于ST段抬高型AMI中适当的冠状动脉病变 ,直接冠脉内支架置入术不仅可以减少X线曝光时间和造影剂用量 ,而且可能改善患者的心肌组织再灌注和近期预后。Objective To assess the significance of emergency direct coronary stenting in patients with acute myocardial infarction of ST-segment elevation(STAMI). Methods 133 patients with STAMI received direct coronary stenting(DS,n=85) or conventional post-dilatation stenting(CS,n=65). The conditions of intervention procession, TIMI grade and electrocardiogram after intervention, left ventricular ejection fraction(LVEF) and major adverse cardiac events(MACE) in hospital were compared between patients receiving DS and patients receiving CS. Results There were no significant differences in general clinical characters, the conditions of TIMI 3 and no-reflow between the two groups(P>0.05). But the time of X-ray exposure and the amount of contrast agent were significantly less(P<0.05), and LVEF was significantly higher (P<0.05) in patients receiving DS than patients receiving CS. The incidence of no ST-segment resolution and MACE in hospital decreased in patients receiving DS(P<0.05). Conclusion For the properly selected lesions in STAMI, direct stenting may not only reduce the time of X-ray exposure and the amount of contrast agent, but also improve myocardial reperfusion and recent prognosis.

关 键 词：急性心肌梗死 经皮经腔冠状动脉成形术 支架 再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]