经皮冠状动脉介入治疗急性下壁心肌梗死的临床分析  

Characteristics of the relative arteries of acute inferior myocardial infarction and the percutaneous coronary intervention

作　　者：李志立[1] 曹义战[2] 张薇[1] 王洪涛[1] 杨欣国[1] 薛玉生[1] 郑强荪[1] 王毅[1] 汤雁玲[1] 金葵花[1] 吴学勤[1] 

机构地区：[1]解放军第四军医大学唐都医院心血管内科,陕西西安710038 [2]解放军第四军医大学唐都医院急诊科,陕西西安710038

出　　处：《中国急救医学》2012年第5期387-389,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 分析经皮冠状动脉介入治疗（PCI）急性下壁心肌梗死（AIMI）的特点,以提高诊治水平.方法 选择冠状动脉造影确诊的AIMI患者151例,其中男性145例,女性6例.回顾性分析梗死相关动脉的特点及PCI术前、术中无复流发生率等临床特点.结果 与〈12 h组比较,12 h后行PCI无复流率（53.8%vs 15.8%,P〈0.01）和低血压发生率（80.8%vs 36.8%,P〈0.01）明显增加,再灌注心律失常发生率两组比较差异无统计学意义;与正常窦律组比较,房室传导阻滞（AVB）组右冠状动脉优势型居多（84.4%vs 63.0%,P〈0.01）,无复流率增加（53.1%vs 13.9%,P〈0.01）;使用Diver CE明显降低无复流的发生（24.3%vs 9.1%,P〈0.01）.结论 尽早行PCI是抢救AIMI患者的关键措施.伴有AVB或低血压时,即使时间超过24 h亦应进行PCI.使用血栓抽吸导管可有效降低无复流的发生.经使用过的球囊注入尿激酶治疗无复流,是简单实用、经济、有效的方法.Objective To analyze the characteristics of the relative arteries of acute inferior myocardial infarction（AIMI） and the percutaneous coronary intervention （PCI）. Methods A total of 151 patients with AIMI identified by coronary angiography were studied. The relative arteries and the clinical features such as no reflow rate and hypotension during PCI were analyzed. Results Compared with 〈 12 h group, the rate of the no reflow and hypotension during PCI were significantly higher in 〉 12 h group （53.8% vs 15.8% and 80.8% vs 36.8%, P 〈0. O1 ）. The rate of the reperfusion arrhythmias was similar in two groups. Compared with the normal rate group, the rate of the no fellow and right dominant coronal artery were significantly higher in the atrioventricular block （AVB） group （84.4% vs 63.0% , 53.1% vs 13.9% , P 〈0.01 ）. The no reflow rate was significantly lower after using the Diver CE device （24.3% vs 9.1%, P 〈 0. Ol ）. Conclusion It is the key measure to save the AIMI patients with PCI as soon as possible. The patients with AVB or hypotension should undergo PCI even more than 24 h. It is suggested that removing thrombus devices be used to prevent the no reflow. It is a single, economic and effective method to treat no reflow with urokinase through the used -balloon.

关 键 词：心肌梗死 冠状动脉 经皮冠状动脉介入治疗(PCI) 无复流 

分 类 号：R654.2[医药卫生—外科学]