急诊经皮腔内冠状动脉成形术治疗急性心肌梗死  

Emergent percutaneous transluminal coronary angioplasty in acute myocardial infarction

作　　者：葛永贵[1] 张群林[1] 王家宁[1] 王崇全[1] 王玮[1] 党书毅[1] 张绪国[1] 周荣华[1] 

机构地区：[1]十堰市太和医院心内科,湖北十堰442000

出　　处：《临床心血管病杂志》2000年第1期25-27,共3页Journal of Clinical Cardiology

摘　　要：目的 :观察急诊经皮腔内冠状动脉成形术 (PTCA)治疗急性心肌梗死 (AMI)的效果。方法 :13例 AMI患者行急诊 PTCA治疗 ,男 10例 ,女 3例 ,年龄 38～ 85 (6 0 .2± 13.6 )岁。其中 6例并发心源性休克 ,3例系溶栓失败后行补救性 PTCA,4例不适作溶栓治疗。梗死相关血管 :前降支 9例 ,右冠状动脉 4例。结果 :PTCA成功率92 .3% ,死亡 1例。术前梗死相关血管狭窄 (98.7± 3.0 ) % ,术后残余狭窄为 (14.6± 16 .2 ) %。 3例术中发生心室颤动 ,1例出现房室传导阻滞 ,1例出现无再流现象 ,经反复冠状动脉内注射硝酸甘油后恢复。术后 1例死亡 ,11例长期生存 ,随访 1～ 18个月无心脏事件发生 ,生活质量明显改善。结论 :AMI时行急诊 PTCA成功率高 ,对溶栓禁忌证、溶栓失败或 AMI并发心源性休克者应积极行急诊 PTCA。To treat patients with acute myocardial infarction by emergent percutaneous transluminal coronary angioplasty.Method:Of 13 patients with acute myocardial infarction (AMI) who undertook PTCA,6 patients had cardiogenic shock,3 patients were failed by thrombolysis,4 patients had contraindications to thrombolysis.Infarct related coronary artery (IRCA) were involved in 9 patients with left anterial descending artery and 4 patients with right coronary artery.Result:PTCA was succesful in 12 of 13 patients (92%).One patient with cardiogenic shock died within half an hour after shock symptoms occured.TIMI grade 3 flow of IRCA was achieved in all of 12 cased with successful PTCA.The stenosis degree of IRCA pre and post PTCA were ( 98.7 ± 3.0 )% and ( 14.6 ± 16.2 )%,respectively.During the procedures,the complications included ventricular fibrillation in 3 cases,atrioventricular block in 1 case and “no flow” phenomena in 1 case.One patient with cardiogenic shock died 7 days later.During a period of 1 to 18 months follow up,long term survivals were achieved in 11 cases ( 84.6 %).Conclusion:Emergence PTCA is an effective therapeutic measure with a high primary success rate in acute myocardial infarction.PTCA should be performed immediately after onset of acute myocardial infarction in patients with contraindications to thrombolysis,cardiogenic shock or failed thrombolysis.

关 键 词：经皮腔内 冠状动脉成形术 心肌梗塞 PTCA 

分 类 号：R542.220.5[医药卫生—心血管疾病]