54例急诊冠状动脉介入的血管影像学分析  

The angiographic characteristics of percuteneous coronary intervention in emergency

作　　者：沈泽宁[1] 罗瑞萍[1] 叶永刚[1] 乐锦艺[1] 何仲海[1] 许建中[1] 

机构地区：[1]上海市长宁区中心医院心内科,200336

出　　处：《上海医学影像》2005年第3期183-185,共3页Shanghai Medical Imaging

摘　　要：目的分析54例急诊冠状动脉介入(PCI)治疗急性心肌梗死(AMI)的血管影像学特点。方法回顾了2002年1月-2004年12月期间,连续54例急诊PCI治疗AMI患者的造影资料,从梗死相关血管(IRA)的部位、形态、钙化、以及PCI术前后的血流灌注情况,来分析急诊PCI时患者的血管影像特点,对溶栓与未溶栓的两组患者作了组间比较。结果(1)急诊PCI的病人近2/3存在2支以上血管病变;(2)溶栓再通率虽然较自发再通率高,差异显著(30.9%vs58.3%,p<0.01),但绝大多数仍为全闭塞或存在严重狭窄(占92.6%),且血流达到3级的较少,因而都需要支架治疗;(3)左冠闭塞部位好发于血管分叉处,即第一对角支开口处;(4)大多数IRA病变不长,平均只有15.06±4.58mm,单个支架可以解决问题;病变长度超过25mm的只有5例,需要两个支架连接;(5)IRA病变处出现钙化较非IRA出现钙化少(5.6%vs22.2%,p<0.01),提示钙化对斑块破裂可能有一定保护作用;(6)支架术后可出现一定比例的无复流(NF)现象,占11.8%,预示远期预后不良;(7)AMI患者冠脉造影可以正常。结论充分预期急诊PCI时IRA的特点,有利于确保手术的成功与术后疗效。Objective To investigate the angiographic characteristics of acute percuteneous coronary intervention（PCI）for acute myocardial infarction （AMI） in past 3 years in our hospital. Methods 54 continuous angiographic data of acute PCI from January 2002 to December 2004 were analyzed. The angiographic characteristics including the location, morphology and calcification of the lesions and the reflow of the infarction related artery （IRA）. Compare the data between the groups with and without thromblysis. Results （1） Nearly 2/3 patients had coronary stenosis in more than two arteries. （2） The rate for achieving reperfusion in thromblysis group was higher than that in no-thromblysis group （30.9% vs 58.3%, p〈0.01 ）. The majority of IRA suffered total occlusion or severe stenosis （92.6%）. Rare of them had TIMI 3 flow, so they needed to implant stent. （3） The occlusion of the left coronary artery usually located at the bifurcation of the first diagonal. （4） The most lesion of IRA was limited, mean length 15.06±4.58mm, only one stent was needed. 5 patients had diffuse lesion, need two continuous stents. （5） IRA usually without calcification （5.6% vs 22.2%0, P〈0.01）, implying calcification can protect the atheroma. （6） No-reflow occurred during procedure in 11.8%. （7） Some acute myocardial infarction occurred without coronary stenosis. Conclusions The understanding of the characteristics of the acute PCI will be helpful for a succeed procedure.

关 键 词：冠状动脉 介入治疗 急诊 影像学 梗死相关血管 急诊PCI 冠状动脉介入 影像学分析 急性心肌梗死(AMI) 溶栓再通率 

分 类 号：R542.22[医药卫生—心血管疾病] R541.4[医药卫生—内科学]