急性心肌梗死合并心源性休克的经皮冠状动脉介入治疗及主动脉球囊反搏治疗疗效  

The efficacy of PCI and IABP in the treatment of acute myocardial infarction complicated with cardiogenic shock

作　　者：陆东风[1] 熊龙根[1] 刘世明[1] 李国强[1] 原萧[1] 梁慧心[1] 温利芳[1] 

机构地区：[1]广州医学院第二附属医院心内科,510260

出　　处：《中国介入心脏病学杂志》2003年第5期267-269,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　观察急性心肌梗死 (AMI)合并心源性休克时在主动脉球囊反搏 (IABP)支持下行经皮冠状动脉成形术 (PTCA)及冠状动脉内支架置入术对患者早期死亡率及心功能的影响。方法　于发病 0 5～ 32h内在IABP支持下行急诊冠状动脉造影 ,对梗死相关血管 (IRA)直接行PTCA及支架置入。 5周内行心脏超声检查及心功能测定。结果　除 4例在行IABP 1h内心衰及休克加重而死亡外 ,余 2 8例患者IRA全部再通 ,置入支架 2 4例 ,成功率 85 71% ,发病至血管再通时间平均 8 6h ,死亡率为 31 2 5 %。 2 2例存活患者 5周内检查射血分数 (EF)为 0 4 3～ 0 6 7。结论　应用IABP作为辅助手段对提高休克病人PCI再灌注非常重要 ;可降低死亡率 ,改善术后近期心功能。Objective To investigate the effect of percutaneous transluminal coronary angioplasty (PTCA) and stent implantation with intraaortic balloon pump (IABP) on immediate death rate and cardiac function of patients with acute myocardial infarction (AMI) complicated with cardiogenic shock.Methods Emergency coronary angiography was taken 0.5-32 h after the attack, and PTCA and stent implantation performed on infarction related artery (IRA), supported by IABP until patients′ complications improved. Myocardial echocardiography was taken 5 weeks after operation.Results Except for 4 patients who died of aggravated shock or cardiac failure, all the patients had IRA reperfusion. Twenty-four patients had stents implanted (85.71%). Mean time from attack to reperfusion was 8.6 h, and death rate in the period of 5 weeks was 31.25%. EF of the 22 patients who survived was 0.43～0.67.Conclusion PTCA and stent implantation supported by IABP can improve results of operation,increase reperfusion rate, decrease immediate death rate and improve cardiac function.

关 键 词：急性心肌梗死 合并症 心源性休克 经皮冠状动脉介入治疗 主动脉球囊反搏 疗效 

分 类 号：R542.22[医药卫生—心血管疾病] R815[医药卫生—内科学]