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补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞 |
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乔树宾 高润霖 陈纪林 姚康宝 杨跃进
秦学文 姚民 刘海波 徐义枢 陈在嘉
【摘要】 目的 探讨补救性经皮冠状动脉腔内成形术（PTCA）在治疗急性心肌梗塞（AMI）中的作用。方法 对溶栓治疗失败的36 例患者进行补救性PTCA治疗。患者心功能Killp分级：Ⅲ级和Ⅳ级4例，Ⅱ级和Ⅰ级32例。冠状动脉造影显示梗塞相关动脉：前降支17例，右冠状动脉14例，回旋支4例，中间动脉1例。PTCA前TIMIⅠ级和Ⅰ～Ⅱ级血流各2例，余32例均为TIMI 0级。36例均进行PTCA治疗，其中13例患者置入了支架。结果 术中除3例失败外，31例患者病变血管血流达到TIMI Ⅲ级，2例TIMIⅡ-Ⅲ级，残余狭窄≤50%，成功率为91.7%。院内并发症：1例在PTCA成功后当天因顽固性休克和心室纤颤死亡；1例于第3天死于心脏破裂，住院病死率为5.6%。14例患者在术后1～2个月内复查冠状动脉造影，2例发生再狭窄。结论 AMI患者在溶栓治疗失败后，在有条件的医院可施行补救性PTCA治疗，成功率高，对改善患者的近期和远期预后可能有利。
【关键词】 心肌梗塞 血管成形术，经腔，经皮冠状动脉
Rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction
Qiao Shubin, Gao Runlin, Chen Jilin, et al. Cardiovascular Institute and Fu wai Hospital, PUMC, CAMS, Beijing 100037
【Abstract】 Objective To evaluate the role of rescue angioplasty for patients with acute myocardial infarction(AMI). Methods Rescue angioplasty was performed for 36 AMI patients. Four patients presented in killp class Ⅲ and Ⅳ, and 32 in Killp class Ⅰ and Ⅱ. The infarct-related artery (IRA) was left anterior descending artery in 17, right coronary artery in 14, left circumflex in 4, intermediate artery in 1. All patients had TIMI 0 flow before PTCA except 2 patients with TIMI Ⅰ flow and the other 2 patients with TIMI Ⅰ-Ⅱ flow. PTCA failed in 3 patients. PTCA was successfully performed in 33 patients, including 13 patients with stent implantation. Results TIMI Ⅲ was achieved in 31 patients, TIMI Ⅱ to Ⅲ flow in 2 patients.So procedural success rate was 91.7%. Inhospital complications included that one died of refractory cardiogenic shock and Vf on the same day of PTCA. Mortality rate was 5.6%. There were 14 patients who were repeatedly performed with coronary angiography within two months and only 2 patients had restenosis. Conclusion For AMI patients who failed to response to thrombolysis, rescue PTCA is the alternative. Results of our early experience in rescue PTCA in a small population demonstrated [1] [2] 下一页
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