急诊介入治疗对老年急性心肌梗死并心原性休克的疗效观察  

Emergency interventional technique in elderly patients with acute myocardial infarction complicated by cardiogenic shock

作　　者：韩雅玲[1] 荆全民[1] 王守力[1] 王冬梅[1] 苗志林[1] 王祖禄[1] 佟铭[1] 刘海伟[1] 

机构地区：[1]沈阳军区总医院全军心血管内外科研究所心内科,110016

出　　处：《中华心血管病杂志》2001年第12期728-731,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨急诊冠状动脉介入治疗对老年急性心肌梗死 (AMI)并心原性休克的近期及中期疗效。方法　对 2 0例平均年龄 (71 4± 6 4)岁的老年AMI患者的 2 1支梗死相关动脉 (IRA)的 2 9处靶病变行急诊介入治疗。术前IRA平均狭窄 (99 9± 0 4) % ,心肌梗死溶栓试验 (TIMI)血流 0级 15例 ,1～ 2级 5例。对其中 15处靶病变置入支架 15枚。结果　病例、IRA及靶病变的介入治疗成功率分别为 95 0 %、95 2 %及 96 6 % ,成功者 94 7%恢复TIMI血流 3级。无因手术并发症及术中死亡发生者。平均开通时间 (19 8± 3 9)min ,术后住院期间 8例 (4 0 % )死亡。发病距治疗≤ 6h的 10例全部存活 ,>6h者仅存活 2例 (P <0 0 1)。对出院的 12例患者随访 7个月以上全部存活 ,无任何不良心脏事件发生。结论　急诊介入治疗 (尤其是急诊冠状动脉支架术 )对高龄AMI并心原性休克高危患者有显著疗效 ,其主要优势为再通快、TIMI血流 3级率高、近期及中期病死率降低 ,发病≤Objective To investigate the short and middle-term effects of emergency coronary intervention in elderly patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS). Methods Twenty elderly patients with AMI (mean age 71.4±6.4 years old )complicated by CS were treated by emergency intervention in their 29 target lesions from 21 infarct related arteries (IRA). Before intervention the mean stenosis of IRA was (99.9±0.37)% and the blood flow was TIMI grade 0 in 15 patients and TIMI grade 1-2 in 5 patients respectively. 15 stents were successfully implanted on 15 target lesions. Results The rates of successful treatment for patients, IRA and target lesions were 95.0%, 95.2% and 96.6% respectively. The TIMI grade 3 blood flow achieved in 94.7% patients with IRA opened successfully. There were no complications and death related to the procedure during operation. The average opening time of IRA was (19.8±3.9) min. Eight patients died after the operation and the total mortality was 40% in hospital. All the 10 patients with the time from onset to revascularization ≤6h survived, while only 2 of 10 patients with the time >6h survived (P<0.01). During the period of follow-up in 7 months, there were not any attack of angina pectoris, re-AMI and other cardiac events in all 12 patients discharged from the hospital. Conclusions The data suggested that emergency coronary intervention (especially emergency coronary stenting) had definitely significant effects in elderly high-risk patients with AMI complicated by CS, and the main benefits of this technique were early reperfusion, higher rate of TIMI grade 3 blood flow and lower rate of short and middle-term mortality, which were more obvious if the intervention started less than 6h since AMI symptom occurred.

关 键 词：心肌梗塞 心原性休克 血管成形术 冠状动脉支架术 老年人 

分 类 号：R542.22[医药卫生—心血管疾病]