急性心肌梗死合并多器官功能不全综合征患者经皮冠状动脉介入治疗的临床疗效  

Percutaneous coronary intervention in patients with acute myocardial infarction complicated with multiple organ dysfunction syndrome:its clinical effect

作　　者：杨桂棠[1] 韩雅玲[1] 荆全民[1] 王守力[1] 王祖禄[1] 王冬梅[1] 

机构地区：[1]沈阳军区总医院心血管内科研究所,沈阳市110840

出　　处：《中华老年多器官疾病杂志》2010年第3期214-216,221,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的评价急性心肌梗死(AMI)合并多器官功能不全综合征(MODS)患者经皮冠状动脉介入治疗(PCI)的临床疗效。方法 2003年1月至2008年12月在沈阳军区总医院心内科住院的AMI合并MODS患者383例,分为急诊PCI组(n=181)和药物治疗组(n=202)。比较两组的基本临床资料、不同器官发生功能不全的比率、发生MODS器官的数目及病死率。结果 PCI组ST段抬高性AMI患者的比例高于药物治疗组(90.6%vs83.2%;P=0.03),其余临床资料两组相似。血管再通率PCI组明显高于药物治疗组(98.3%vs52.5%;P<0.01)。在心脏、肺、肾脏和胃肠发生功能不全的比率两组相似,而在肝脏、脑及血液系统发生功能不全的比率PCI组低于药物治疗组(16.6%vs27.2%,10.5%vs18.8%,2.2%vs7.4%;P<0.05)。2个器官功能不全发生率PCI组高于药物治疗组(65.2%vs54.5%;P=0.04);3个器官功能不全,两组发生率相似;而出现4个或5个器官功能不全时,PCI组的发生率低于药物治疗组(9.4%vs17.3%,2.2%vs7.9%;P<0.05)。PCI组总病死率明显低于药物治疗组(9.9%vs36.1%;P<0.01)。结论尽管AMI合并MODS患者风险大,病死率高,但积极有效地行PCI治疗,仍可获得满意的临床疗效。Objective To investigate the clinical effect of percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI） complicated with multiple organ dysfunction syndrome （MODS）. Methods From January 2003 to December 2008,383 hospitalized patients with AMI and MODS in General Hospital of Shenyang Military Command were divided into PCI group （n=181） and drug treatment group （n=202）. The baseline data,the incidence rate of each dysfunction organ,the number of dysfunction organs and the mortality were compared between the two groups. Results There were more AMI patients with elevated ST segment in PCI group than in drug treatment group （90.6% vs 83.2%; P=0.03）. The other baseline data were identical between the two groups. The revascularization rate in PCI group was much higher than that in drug treatment group （98.3% vs 52.5%; P0.01）. The incidence rate of organ dysfunction,such as heart,lungs,kidneys,stomach and intestine,was not different between the two groups. But in liver,brain and hematological system,the organ dysfunction incidence rate was lower in PCI group than in drug treatment group （16.6% vs 27.2%,10.5% vs 18.8%,2.2% vs 7.4%; P0.05）. The incidence rate of 2 organs dysfunction was higher in PCI group than in drug treatment group （65.2% vs 54.5%; P=0.04）. The incidence rate of 3 organs dysfunction was not different between the two groups. But the incidence rate of 4 or 5 organs dysfunction was lower in PCI group than in drug treatment group （9.4% vs 17.3%,2.2% vs 7.9%; P0.05）. The mortality in PCI group was much lower than that in drug treatment group （9.9% vs 36.1%; P0.05）. Conclusion Although patients with AMI and MODS have high risk and high mortality,the valid PCI treatment still displays satisfactory clinical effects.

关 键 词：心肌梗死 多器官功能衰竭 经皮冠状动脉介入治疗 治疗效果 

分 类 号：R541.4[医药卫生—心血管疾病]