直接与择期经皮冠状动脉腔内成形加支架术治疗AMI效果比较  

Treatment effects of direct and elective PTCA with intracoronary stenting in patients with acute myocardial infarction

作　　者：王瑞莹[1] 许静[1] 吴尚琴 孙姗[1] 付乃宽[1] 王惠中[1] 

机构地区：[1]天津胸科医院心内科,天津300051

出　　处：《郑州大学学报（医学版）》2002年第2期207-209,共3页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的 :比较直接与择期经皮冠状动脉腔内成形加支架术 (PTCA +STENT)中再灌注性心律失常发生率及术后左室功能。方法 :10 3例急性心肌梗死 (AMI)患者 ,分为 2组 :A组 6 4例行择期PTCA +STENT术。B组 39例在发病 12h内行直接PTCA +STENT术。术中冠状动脉造影 (CAG)定位梗死相关动脉 (IRA) ,多导心电生理仪监护再灌注性心律失常 ,根据心律失常不同类型给予相应处理。术后 10～ 2 0d作超声心动图 ,对比左心室射血分数(LVEF)以评价心功能。结果 :①首次CAG显示A组IRA 81支 ,其中左前降支 (LAD) 4 2支 ,右冠状动脉 (RCA) 2 5支 ,左回旋支 (LCX) 14支。B组IRA有 4 4支 ,其中LAD 2 4支 ,RCA 12支 ,LCX 8支。 2组冠状动脉分支阻塞率差异无显著性 (P >0 .0 5 )。②A ,B 2组行PTCA +STENT术中再灌注性心律失常发生率 :A组为 2 5 % (16 / 6 4 ) ,心室颤动发生率为 16 % (10 / 6 4 )。B组为 79% (31/ 39) ,其中心室颤动发生率为 5 4 % (2 1/ 39) ,2组比较差异有显著性 (均为P <0 .0 5 )。 2组心室颤动患者行电除颤后均转复为窦性心率。③住院 10～ 2 0d行二维超声心动图检查显示 ,LVEF≥6 0 %者 ,A组为 6 4 % (41/ 6 4 ) ,B组为 90 % (35 / 39) (P <0 .0 5 )。结论 :AMI患者行直接PTCA +STENT术与择期PTCAAim:To compare occurrence rate of reperfusion arrhythmia and the left ventricular ejection function between direct and elective PTCA and intracoronary stenting in the patients with acute myocardial infarction (AMI). Methods:One hundred and three consecutive patients with AMI were undergone either elective PTCA and intracoronary stenting (Group A, 64 patients) or direct PTCA and intracoronary stenting (Group B, 39 patients) from August 1998 to July 2001. The infarct related artery (IRA) was orientated by coronary angiography ( CAG).The reperfusion arrhythmia was recorded by heart electricity physiology apparatus. Left ventricular ejection function (LVEF) was measured by two dimensional echocardiography and cardiac events were handled during follow up.Results:① The first CAG showed that the IRA was 81 branches in group A, and 44 branches in group B. The difference of the obstruct rates between group A and group B was not significant ( P >0.05). ② The rate of reperfusion arrhythmia in patients of group A was 25%, while in group B was 79%. The rate of ventricle fibrillation in patients of group A was 16%, and in group B was 54%. The difference between group A and group B was significant ( P <0.05). ③ At 20 day follow up, the rate of LEVF≥ 60% in Group A was 64%; in Group B was 90% ( P <0.05). Conclusion:The patients of direct PTCA and intracoronary stentiwg was treated earlier, The reperfusion arrhythmia during the operation is more obvious and the cardiac function after acute period is better in the patients of elective PTCA and intracoronary stenting.

关 键 词：急性心肌梗死 再灌注性心律失常 左心室射血分数 经皮冠状动脉腔内成形加支架术 超声心动图 

分 类 号：R542.22[医药卫生—心血管疾病]