摘要
目的 探讨急性心肌梗死 (AMI)合并心源性休克患者的冠脉病变特点及再灌注疗法的效果。方法 以74例AMI患者为对象 ,按是否合并心源性休克分为休克组 16例 ,非休克组 5 8例 ,对比两组患者的临床资料 ,冠脉造影及再灌注疗法对预后的影响。结果 休克组院内病死率显著高于非休克组 (P <0 0 5 ) ;休克组各种并发症比例均显著高于非休克组 ,其中梗死延展休克组发生率为 38% ,非休克组为 5 % (P <0 0 1) ;冠脉造影显示 ,休克组 3支病变显著高于非休克组 (P <0 0 1) ,前者 99%以上的严重狭窄病变多、钙化严重及侧支循环发育不良。再灌注治疗后 ,梗死相关冠脉再通率休克组显著低于非休克组 (P <0 0 5 ) ,休克组院内病死率受梗死相关冠脉再通与否的影响 ,再通的 6例仅 1例死亡 ,而未再通的 5例 3例死亡。结论 AMI合并心源性休克患者 ,冠脉病变严重、复杂 ,病死率高 ,改善预后的关键是恢复再灌注及预防梗死延展。
Objective To investigate coronary angiographic findings and the effect of reperfusion therapies in patients with acute myocardial infarction(AMI)complicated with shock.Methods 16 shock patients and 58 patients without shock were comparatively studied to observe clinical characteristics,coronary angiographic findings and the effects of reperfusion therapies on prognosis. Results In shock group,the in-hospital mortality rate was significantly higher than that without shock(25% vs 5%,P<0 05).Frequency of various severe complications were significantly higher in the former than the latter.The occurrence of “extension”was 38% in shock group,it was significantly higher than that without shock(P<0 01).Coronary angiographic findings revealed that extensive three-vessel disease was a more common finding in patients with shock than those without(53% vs 8%,P<0 01).Other angiographic findings,such as the ≥99% stenosis,more severe calcification and poor development of collaterals to the infarct-related artery(IRA),were more in shock cases(P<0 01).Success rate after reperfusion therapies was significantly lower in shock group than that without shock(55% vs 86%,P<0 05).Concerning these shock patients,in-hospital mortality rate seemed to depend closely upon IRA patency.Only one of the six patients with patency died,meanwhile three of fives without patency died.Conclusion AMI patients with cardiogenic shock had more severe coronary artery disease and higher mortality.The establishment of patency of the IRA is the most important therapeutic strategy for improving prognosis. The prevention of extension might reduce the incidence of cardiogenic shock.
出处
《中国实用内科杂志》
CSCD
北大核心
2000年第5期279-281,共3页
Chinese Journal of Practical Internal Medicine
关键词
急性心肌梗塞
心源性休克
再灌注疗法
Acute myocardial infarction Cardiogenic shock Reperfusion therapy
