急性心肌梗死静脉溶栓后急诊补救性PTCA+支架术的临床评价  

The clinical evaluatian of rescue emergency PTCA + stenting following thrombolytic therapy in acute myocardial infarction

作　　者：高华 张志寿[2] 张华 

机构地区：[1]山西吕梁荣军医院,山西离石033000 [2]解放军总医院,北京100853 [3]北京医星医院,北京100071

出　　处：《心脏杂志》2005年第2期147-148,共2页Chinese Heart Journal

摘　　要：目的观察急性心肌梗死(AMI)静脉溶栓后仍有胸痛或血流动力学不稳定、急性左心功能不全以及心律失常、病态窦房结综合征(SSS)、Ⅲ°AVB、阵发性室速等状态下,紧急行PTCA+支架术对抢救患者的生命的疗效及安全性。方法12例AMI患者均在外院行尿激酶溶栓后,心电图无变化,仍伴有胸痛、低血压、心源性休克、SSS、心动过缓、Ⅲ°AVB、阵发性室速、左心功能不全等其中一项或多项,在24h内紧急行PTCA+支架治疗。介入治疗术前及术后观察患者的症状、心率、血压,应用超声心动图测心室功能的动态变化情况。结果5例胸痛患者通过PTCA+支架术后,胸痛完全消失,2例术前伴有心源性休克及左心功能不全的患者术后6h血压比术前明显升高,术后心率明显减慢,12h超声心动图测心室功能明显改善,5例伴有心动过缓及低血压患者术后6h血压显著升高,心率较术前明显提高。结论AMI静脉溶栓后仍有血流动力学不稳定的状态下,治疗的关键是尽早使完全或近似完全梗死的血管再通,行急诊补救性PTCA+支架是十分有效和较为安全的方法。AIM:To observe the safty and efficiency of rescue emergency PTCA+stenting following thrombolytic therapy in acute myocardial infarction(AMI) with angina, invariable ECG,unstable hemodynamics,acute left ventricular failure, cardiac arrhythmias (SSS, Ⅲ°AVB,VT). METHODS: 12 patients with AMI underwent intravenous thrombolytic out-hospital, however, of whom had invariable ECG,angina,hypotension,cardiogenic shock, bradycardia, SSS, Ⅲ°AVB,VT, left ventricular failure,All of cases undervent rescue emergency PTCA+stenting within 12 hours after AMI and changes of symptom,BP,HR were observed,especially left ventricle ejection fraction (LVEF) was evaluated by echocardiograph between pre-operated and post-operated. RESULTS: The angina in 5 cases was completely alleviated after operation.The cardiogenic shock and the left ventricular failure in 2 cases was improved obviously, result in inprovement of BP,HR,LVEF within 6 hours after operation.The BP and HR raise in 5 cases with bradycardia and/or hypotension. CONCLUSION: It's important in AMI following thrombolytic with unstable hemodynamics to reopen infarction relative artery.The rescue emergency PTCA+stenting following thrombolytic therapy is a rational,safety and efficient,The patient in AMI following thrombolytic therapy with unstable hemodynamics is easy accompany with acute left ventricular failure or cardiogenic shock, whose mortality is high.

关 键 词：心肌梗塞 急性 静脉溶栓 支架术 

分 类 号：R542.22[医药卫生—心血管疾病]