急性心肌梗死经皮冠状动脉成形术治疗的近期疗效  

Short-term efficacy of percutaneous transluminal coronary angioplasty in the treatment of acute myocardial infarction

作　　者：陆东风[1] 熊龙根[1] 刘世明[1] 陈传荣[1] 李昭骥[1] 梁慧心[1] 原潇[1] 

机构地区：[1]广州医学院第二附属医院心内科,广州市510260

出　　处：《岭南心血管病杂志》2001年第2期88-91,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的　观察急性心肌梗死 (AMI)经皮冠状动脉成形术 (PTCA)及原发性冠状动脉内支架植入术的近期疗效。方法　 2 0 4例AMI患者发病 0 5～ 2 6h内行急诊冠状动脉造影 (CAG) ,证实冠状动脉闭塞 ,仅对梗死相关血管直接行PTCA及原发性冠状动脉内支架植入。结果　全组 2 0 4例患者再通 197例 ,成功率 96 % ,发病至血管再通的时间 1～2 7h ,平均 5 6h。PTCA失败 7例 ,其中心包填塞 2例 ,钢丝不能通过 3例 ,术中死亡 2例 (均发生在伴有心源性休克的前壁心肌梗死患者 ) ,死亡率为 0 9% ,5周内死亡 2例 (经PTCA及支架植入术后心功能未明显改善 ,死于心功能不全 ) ,2～ 6个月死亡 6例 (因再发心肌梗死而死亡 ) ,总死亡率 4 9%。结论　AMI后早期 (6h内 )成功的再灌注可挽救濒死的心肌、缩小梗死面积和明显降低死亡率 ,即使在较晚时间(>12h) ,病人仍有胸痛及ST段抬高 ,使梗死的血管再通仍可达到治疗的目的。早期充分的再灌注可明显改善患者的预后。急诊PTCA治疗 ,可使开通闭塞血管的时间提前 ,PT CA后残余狭窄甚微 ,再灌注血流充分 ,极少发生恢复期心肌缺血及心功能不全。在条件比较好的大型医院 ,PTCA是治疗AMI的最佳方法。Objective To investigate the short term efficacy of percutaneous transluminal coronary angioplasty(PTCA) in the treatment of acute myocardial infarction (AMI). Methods Recanalization of the infarct related artery in the early hours after AMI is of greet benefit and consequently remarkably reduces morbidity and mortality. Between August 1994 and December 1999, 204 patients (aged 32～90 years, 138 males) with AMI were treated with direct PTCA and implantation of coronary stents, including inferior myocardial infarction (96 cases) and anterior myocardial infarction (108 cases ). All subjects were verified by electrocardiogram, clinical presentation and/or cardiac enzyme series, and the time of onset of symptom ranged from 0.5 to 26 hours, with a mean time of 8 hours. Among them, there were 5 patients with anterior myocardial infarction and cardiogenic shock, and 15 patients with anterior myocar dial infarction and cardiac insufficiency. After admission, all patients received routine premedication (aspirin), then, direct PTCA and primary implantation of coronary stents were carried out in all patients after a diagnostic immediate coronary angiography (CAG). Results PTCA was successful in 197 (96%) of the 204 patients. The time from the onset of symptom to angioplasty ranged from 1 to 27 hours (mean 5.6 h). Among the 7 patients with unsuccessful PTCA, in 2 the failure was due to cardiac tamponade, in 3 to inability to cross the lesion and in 2 to deaths occurred in the patients presenting with cardiogenic shock during the procedure, the mortality rate was 0 9%. 2 patients died of cardiac insufficiency within 5 weeks of successful operation, the overall mortality rate was 1 96%.Conclusion Early reperfusion(<6 h) in AMI can save jeopardized myocardium, reduce infarct size, markly decrease mortality and alleviate the prognosis, moreover, the benefit can also be achieved in the patients with chest pain and ST segment elevation 12 hours after the onset of symbtom. Direct PTCA can esult in earlie

关 键 词：急性心肌梗死 经皮冠状动脉成形术 死亡率 治疗 

分 类 号：R542.220.5[医药卫生—心血管疾病]