摘要
目的：本研究旨在评价经皮冠状动脉（冠脉）内超声消融治疗急性心肌梗死（AMI）的疗效与安全性。方法：研究对象为20例AMI的患者（男18例，女2例，年龄523±11.2岁），随机分为PTCA组12例和经皮冠脉内超声消融血栓（CUA）加PTCA组（CUA＋PTCA组）8例。梗塞相关冠脉前降支14例，左回旋支1例，右冠脉5例。结果：CUA＋PTCA组8例超声治疗136±48s后胸病在8～15min内缓解，PTCA组12例胸痛在20～25min内缓解。冠脉造影示CUA＋PTCA组超声溶栓后即刻最小管腔直径（MLD）由开始时的0mm增大至1．43±0.24mm（P＜0．001），％D由开始时的100％降低至56．09％±15.57％（P＜0.001），TIMI由开始时的0级增加至3级。加行PTCA术后即刻MLD增大至3.08±0.42mm，狭窄直径百分比（％D）降低至5.29％±0.34％（P＜0.001）。单独PTCA组12例术后即刻MLD由术前的0mm增大至2．87±0.49mm，％D由开始时的100％降低至10.27％±4.36％（P＜0.001）。腔内超声显像CUA＋PTCA组超声溶栓后即刻冠脉内膜面极少量残留血栓；PTCA组术后即刻冠脉内膜面大量血栓。CUA＋PTCA组超声溶栓后均无夹层分离等并发症，随访1～10个月无心绞痛发作；PTCA组有夹层分离等并发症发生，2例于术后3～4个月发作心绞痛，再狭窄率分别为68.12％与88.59％。结论?
Purpose: To evaluate the efficacy and safety of perutanoous transluminal coronary ultrasound ablation (CUA) in patients with acute mndial infarction (AMI). Methods: 20 Patients (mean age 52. 3 ±11. 2 years) with AMI wer included for clinica study. They were randowhy assigned to CUA with adunctive PTCA group (n = 8) and na alon groIJp (n = 12). Treated lesions were in the left anterior daseending branch (n = 14), drcurnflex branch (n = 1) and right coroary artery (n = 5). Results: In 8 patients after treated with CUA for 136 ±48 ar, chest twn was ralieved within 8 to 15 ndnutes, whereas chest pain was alleviated within 20 to 25 minutes in 12 patients with PTCA alone. be angiogrphy revealed that the pemtage of the cliameter stenosis(%D)of the infarcted arteries decnd frn 100 % to 56. 09 % ±15. 57 % (P <0. 001) after CUA and to 5. 29 % ±0. 34 % (P<0. 001)after FTCA, and that the Annirnal ltimen diameter increased from 0 mm to 1. 43 ±0. 24 mm (P < 0.001) after CUA and to 3. 08 ±0. 42 mm after PTCA (P<0.001). Angiographic findings shown TIMI grade incrrased from grade 1 to grade 3 after application of CUA. In PTCA alone group, MLD increased from 0 mm to 2. 87 ±0. 49 mm, and %D decnd from 100 % to 10. 27 % ±4. 36 %(P<0. 001) after PTCA. Intravascular ultnd itwng indicated that with CUA ther was little tbos on the surface of the lumen, whereas much more thrombus adhered to the lumen without CUA. No vessel dissection or mechanical injtiry to the coronary arteries treaed with CUA were found. Conclusions: Catheter delivered ultrasound energy can be effecively and safely used for percutaneous transluminal coronary ablation to treat the patients with AMI.
出处
《中国临床医学》
1999年第3期217-219,共3页
Chinese Journal of Clinical Medicine
基金
上海市医学领先专业重点学科资助!94-Ⅲ-001
关键词
心肌梗塞
超声消隔术
血管成形术
Myocardial Infarction Ultrasound ablation Angioplasty
