经皮冠状动脉介入治疗时机对急性心肌梗死患者预后的影响  

The efficacy and complication of different plans of therapy in acute myocardial infarction

作　　者：韩艳丽[1] 王营[1] 吴一楠[1] 方征[1] 姜红菊[1] 左岩霞[1] 王健[1] 刘芳[1] 李继福[2] 

机构地区：[1]济南铁路中心医院,山东济南250001 [2]山东大学齐鲁医院

出　　处：《山东医药》2003年第23期1-3,共3页Shandong Medical Journal

摘　　要：目的　探讨经皮冠状动脉介入术 ( PCI)治疗急性心肌梗死 ( AMI)的最佳时机。方法　将 14 6例AMI接受 PCI治疗者分为四组。急诊直接 PCI组 (急诊组 ) 45例 ,溶栓后梗死相关动脉 ( IRA)未通行补救 PCI组(补救组 ) 3 1例 ,溶栓后 IRA开通行延迟 PCI组 (延迟组 ) 3 2例 ,未行溶栓 4周内择期 PCI组 (择期组 ) 3 8例。延迟及择期组术中对严重狭窄的非 IRA同时进行处理。对所有患者随访 3～ 12个月 ,观察心血管事件的发生情况。结果　 14 6例患者 IRA14 9支 (其中 3例为双支 IRA) ;14 9支 IRA及 3 5支非 IRA行支架置入 ,14 5例获有效血运重建 ,IRA支架的置入率为 10 0 % ,扩张后即刻造影结果平均残余率 <10 % ,手术成功率 99.3 %。术中 3 8例出现无再流现象 ,急诊组及补救组发生率高于后两组 ,P<0 .0 5。术后死亡 4例 ,择期组高于其他三组 ,P<0 .0 5。再发心绞痛者 19例 ,急诊组及补救组低于另外两组 ,P<0 .0 5;择期组再发 AMI1例。结论　 PCI是治疗 AMI的积极有效的方法 ,急诊 PCI即刻手术成功率高 ,补救 PCI是抢救高危患者的有效方法 ,两种方法术中无再流的发生率较高 ,但效果最好 ;延迟 PCI、择期 PCI能改善患者预后 ,但易出现严重心血管事件。Objective To evaluate the efficacy and complication of different plans of therapy in acute myocardial infarction(AMI).Methods Total 146 patients with AMI received 4 different plans of percutaneous coronary intervention(PCI),direct PCI in 45 patients,rescue PCI in 31 patients who failed in reperfusion after intravenous thrombolysis,late elective PCI in 32 patients who were shown successful angiograghic reperfusion after intravenous thrombolysis and selected PCI in 38 patients who didn't undergo intravenous thrombolysis in 4 weeks.Clinical events were followed up for 3 to 12 months.Results The infarct related arteries (149)were successfully re opened in all 146 PCI patients.In some elective and selected PCI patients,the severe stenotic no infarct related arteries (35) were completely dilated.Stents were implanted in 100% infarct related arteries.The average residual stenosis was<10%.The rates of successful PCI were 99.3%.The rates of no reflow phenomenon in direct and rescuePCI group were higher than that in elective and selected group(P<0.05).The mortality of selected PCI group was higher than that in direct?rescue and elective PCI group(P<0.05).The rates of angina pectoris in direct and rescue PCI group were lower than that in elective and selected group( P<0.05 ).Conclusion Percutaneous coronary revascularization in AMI has a higher success rate and less serious complication.Compared with elective and selected PCI,direct and rescue PCI have a higher rate of no reflow phenomenon,but the patients could get the most profits.

关 键 词：择期 治疗 患者 AMI 术中 溶栓 急诊 PCI 时机 开通 

分 类 号：R542.22[医药卫生—心血管疾病] R654.2[医药卫生—内科学]