无保护左主干的急诊介入治疗  

Urgent percutaneous coronary intervention （PCI） in unprotected left main coronary artery lesion

作　　者：陈曦[1] 土井修 望月守 屈百鸣[1] 吴立萱[1] 车贤达[1] 

机构地区：[1]浙江省人民医院心内科,杭州310014 [2]日本静冈县立综合病院

出　　处：《中华急诊医学杂志》2007年第4期369-372,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨经皮冠状动脉介入治疗（PCI）在左主干（LMT）病变急性闭塞或狭窄所致急性心肌梗死（AMI）中的有效性和安全性。方法选择13例LMT急诊PCI病例，其中开口部2例、体部2例、分叉部7例、从开口到分叉全部累及2例。所有病例均在主动脉内囊反搏（intreaortic balloon pamp，IABP）支持下进行，其中4例在经皮心肺辅助系统（percutaneous cardio—pulmonary support，PCPS）支持下进行手术。13例患者中有1例仅做了血栓吸引术；3例血栓吸引术后直接支架置入；3例血栓吸引术及球囊预扩后再置入支架；其余4例为球囊预扩后再置入支架。术后存活患者均在3个月、6个月和12个月分别行冠状动脉造影（coronargartery angiogrophy，CAG）含或不含血管内超声复查。结果13例患者中共死亡5例，其中2例死于手术后1d之内，2例死于CCU，另一例猝死于术后17个月；存活的8例中有4例在一年内接受外科的冠脉搭桥术coronary artery bypass graft（CABG），另4例心功能均有不同程度得到改善。结论IABP支持下急诊PCI治疗可以挽救部分患者的生命和改善预后。Objective To explore the efficacy and safety of pereutaneous coronary intervention （PCI） in acute myocardial infarction induced by acute occlusion or severe stenosis of left main coronary artery. Method Thirteen patients were enrolled, of them, 2 cases were ostium lesion, 2 mid shaft lesion, 7 bifurcation lesion, and 2 both ostium and bifurcation lesion. All cases were under intra-aortie balloon pump （IABP）. Four cases were under pereutaneous cardio-pulmonary support （PCPS）, and one of the 13 cases underwent only PereuSurge clot extraction. Three cases were implanted stents after PercuSurge clot extraction. Three cases were implanted stents after PereuSurge clot extraction and balloon pre-dilation. Four cases were implanted stents after balloon pre-dilation. And all survival patients were taken coronaryartery angiogrophy （CAG） with or without intravascular ultiasound （IVUS） within 3, 6 and 12 months. Results Five patients died. Of them, 2 patients died 1 day after procedure, 2 patients died in CCU, and one died of sudden cardiac arrest 17 months after procedure. Eight patients survired, and of them, 4 patients underwent coronary artery bypass graft （CABG） within 1 year and cardiac function in other 4 patients improved to a certain extent. Conclusions Urgent PCI under IABP saving life of the patients with lesion of LMT and improve the prognosis outcome.

关 键 词：无保护左主干病变 急性心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R686[医药卫生—骨科学]