急诊经皮冠状动脉介入治疗急性心肌梗死死亡因素分析  

Analysis of succumbed reasons of emergent percutaneous coronary intervention in treatment of acute myocardioal infarction

作　　者：王勇[1] 刘晓飞[1] 李宪伦[1] 曾玉杰[1] 石兵[1] 彭文华[1] 施乐[1] 柯元南[1] 

机构地区：[1]中日友好医院心内科,北京100029

出　　处：《中华急诊医学杂志》2006年第10期876-878,共3页Chinese Journal of Emergency Medicine

摘　　要：目的分析急性心肌梗死患者行急诊经皮冠状动脉介入治疗(PCI)手术中及住院期间死亡原因。方法1999年3月至2005年6月行急诊PCI治疗的急性心肌梗死患者623例,死亡27例,回顾性分析其死亡原因及临床特征。结果死亡27例,病死率4．3%,年龄51～91岁,(69±18)岁。三支病变16例．二支病变10例．单支病变1例。合并陈旧心肌梗死10例,糖尿病9例．高血压病19例,肾功能损害4例,陈旧性脑梗死6例。死亡原因：心源性休克9例,无复流6例,心脏破裂2例,急性血栓形成2例,急性左心功能衰竭2例,急性肾功能衰竭2例,颅内出血2例,穿刺处出血致休克1例,急性心包填塞1例。结论急性心肌梗死急诊介入治疗死亡原因有多种,心源性休克、无复流为主要死亡原因。高龄、多支病变、合并糖尿病、陈旧性心肌梗死等可能为死亡的预测因子。Objective To analyze the succumbed reasons of emergent percutaneous coronary intervention （EPCI） in treatment of acute myocardial infarction （AMI） during operation and in-hospital period. Method During March 1999 to June 2005, 623 AMI patients received EPCI, and 27 patients died. The succumbed reasons and clinical characteristics of the succumbed patients were analyzed. Result Among the 27 succumbed patients, with age 51 to 91 （69 ± 18） years old, 16 had three-vessel lesions, 10 had two-vessel lesions and 1 had single vessel lesion. Ten patients were accompanied with old myocardial infarction, 9 with diabetes mellitus, 19 with hypertensions, 4 with impaired renal functions, and 6 with old cerebral infarction. Nine patients died of cardiogenic shocks, 6 died of no-reflows, 2 died of heart ruptures, 2 thrombosis, 2 acute left heart failure, 2 acute renal failure, 2 intracranial hemorrhage, 1 shock due to hemorrhage of puncture position, and 1 acute pericardiac tampenade. Conclusion The succumbed reasons of EPCI in treatment of acute myocardial infarction were various. Cardiac shock and no-reflow were primary reasons. Old age, multi-vessel lesion, diabetes mellitns, and old myocardial infarction may serve as predicting factors.

关 键 词：冠心病 心肌梗死 急诊经皮冠状动脉介入治疗 死亡因素 

分 类 号：R542.22[医药卫生—心血管疾病]