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Ｋｉｌｐ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ＴＩＭＩ０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ＴＩＭＩⅢ级，２例ＴＩＭＩⅡⅢ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。
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 high procedural success rate. Rescue PTCA may be benefitial to the short term and long term outcome of patients with AMI.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
1998年第6期426-428,共3页
Chinese Journal of Cardiology
关键词
心肌梗塞
血管成形术
PTCA
AMI
myocardial infarction angioplasty, transluminal, percutaneous coronary
