机械通气支持下行紧急介入治疗急性心肌梗死并发肺水肿  

Efficacy of Percutaneous Coronary Intervention Plus Mechanical Ventilation in the Treatment of Acute Myocardial Infarction Complicated with Pulmonary Edema

作　　者：方快发[1] 刘文兵[1] 饶志荣[1] 王宁生[1] 杨友祥 

机构地区：[1]惠州市惠阳第一人民医院CCU病区,广东惠州516211

出　　处：《中国呼吸与危重监护杂志》2010年第3期281-283,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨急性心肌梗死并发肺水肿患者在机械通气支持下,进行紧急冠状动脉介入治疗(PCI)的可行性。方法回顾性分析2007至2009年在急诊室确诊急性心肌梗死并发肺水肿,在机械通气支持下行紧急PCI的15例患者的病历资料,分析其临床资料、左室射血分数、血浆脑钠肽(BNP)及高敏C反应蛋白(hs-CRP)水平。结果 15例患者全部手术成功,病情恢复良好并逐步脱机,左室射血分数(LVEF)显著改善[机械通气支持介入结束后EF为(37.36±0.02)%,脱机前EF为(47.41±0.02)%,P<0.05);血浆脑钠肽水平[介入治疗前为(430.50±96.08)fmol/mL,介入治疗后4周为(99.34±5.15)fmol/mL]和血清hs-CRP浓度[介入治疗前为(89.50±9.30)ng/mL,介入治疗后4周为(8.35±2.49)ng/mL]随治疗时间逐渐降低(P均<0.01)。结论急性心肌梗死肺水肿患者在呼吸机支持下行紧急PCI治疗具有可行性和较好的疗效。Objective To evaluate the feasibility and efficacy of emergency percutaneous coronary intervention（PCI） under mechanical ventilation for the treatment of patients with acute myocardial infarction complicated with acute pulmonary edema.Methods The clinical data of 15 patients admitted to the emergency ward for acute pulmonary edema caused by acute myocardial infarction from 2007 to 2009 were retrospectively analyzed.These patients received emergency PCI under mechanical ventilatory support.Parameters involved changes of symptoms,arterial blood gas,left ventricular ejection fraction（LVEF）,plasma concentrations of B-type natriuretic peptide（BNP）,and high sensitivity reactive protein（hs-CRP）.Results All patients showed significant improvements in dyspnea,artery blood gas parameters after PCI（P0.01）.LVEF increased significantly after PCI compared with before weaning [（37.36±0.02）% vs （47.41±0.02）%,F=461.47,P0.05].The concentrations of BNP and hs-CRP returned to lower level 4 weeks after PCI [（99.34±5.15） fmol/mL vs （430.50±96.08） fmol/mL,（8.35±2.49）ng/mL vs （89.50±9.30） ng/mL,both P0.01].Conclusion Emergency PCI under mechanical ventilatory support is a feasible and effective approach for patients with acute myocardial infarction complicated with acute pulmonary edema.

关 键 词：心肌梗死 急性肺水肿 冠状动脉介入治疗 机械通气 

分 类 号：R542.22[医药卫生—心血管疾病]