急诊直接冠状动脉内支架术治疗急性心肌梗塞的效果观察  

Stenting treatment for emergency AMI patients

作　　者：邝日禹 覃远文 

机构地区：[1]广西桂东人民医院心内科,543001

出　　处：《广西医学》2003年第4期520-522,共3页Guangxi Medical Journal

摘　　要：目的 :观察急诊直接冠状动脉内支架术治疗急性心肌梗塞 (AMI)的安全性和有效性。方法 :对 2 0例 AMI患者在发病 12小时内行直接经皮冠状动脉腔内成形术 (PTCA )并植入冠状动脉内支架 (Stent) ,其中有 2例心源性休克患者。梗塞相关动脉 (IRA)共 2 2支 :左主干 1例 (4 .5 5 % ) ,前降支 14例 (6 3.6 4 % ) ,回旋支 3例 (13.6 4 % ) ,右冠脉 4例 (18.18% ) ;TIMI血流分级 (2 2支 ) :0级 17支 (77.2 7% ) ,1级 3支 (13.6 4 % ) ,2级 2支 (9.0 9% )。全组病例共处理病变血管 2 6条 ,植入支架 2 9枚。结果 :2 0例患者支架植入手术成功率达 10 0 % (2 0例 ) ,其中 IRA支架植入成功率 90 .9% (2 0 / 2 2 ) ,IRA植入支架后残余狭窄均 <2 0 % ,IRA血流全部达到 TIMI3级。有 4例患者行 IRA支架植入后同时行其它非 IRA的支架植入成功。住院期间有 1例死于脑出血 ;1例术后第 8天送上级医院行室间隔穿孔修补术 ,2天后死于上级医院。其余 18例术后至出院均未发生严重心脏事件 ,平均住院 (16± 4 .5 )天。结论 :急诊直接冠状动脉内支架术对急性心肌梗塞的治疗可能是安全。Objective:To observe the safety and effectiveness of emergency intracoronary stents in acute myocardial infraction patients Methods:Twenty patients of AMI were treated with PTCA and implanted intracoronary stents within 12 hours.Of which,2 cases were cardiogenic shock.Among 22 cases of infarcted related arteries (IRA),there were 1 LM(4 55%),14 LAD(63 64%),3 LCX(13 64%),4 RCA(18 18%).As for TIMI,17 arteries were in the first degree;3 arteries in the second degree and 2 arteries in the third degree.Twenty six arteries were treated during the whole study,and twenty nine stents were implanted Results:Intracoronary stent was successful in 20 patients,90 9% of IRA stent implantation were successful,their residual stenosis were less than 20%.Blood flow of IRA reached TIMI third degree(4 patients were implanted stents both in IRA and non IRA successfully).After operation,One patient died of cerebral hemorrhage,One patient was sent to upper level hospital for repairing of perforation of interventicular septum 8 days after treatment and died the second day.No serious cardiac complications occurred in the other 18 patients.An average of hospitalization was (16±4 5) days Conclusion:Emergency intracoronary stents in AMI patients may be safe and efective

关 键 词：急诊 直接冠状动脉内支架术 急性心肌梗塞 

分 类 号：R542.22[医药卫生—心血管疾病]