补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞.doc

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1、补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞2010-12-15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(AMT)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：川级和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TTMTI级和I〜II级血流各2例，余32例均为TTMT0级。36例均进行PTCA治疗，其屮13例患者置入了支架

2、。结果术屮除3例失败外，31例患者病变血管血流达到TTMT级,2例TTMTIT-ITT级，残余狭窄W50%,成功率为91.7%o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%o14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AMT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Rescuepercutaneoustransluminalcoronaryangioplastyforacutemyo

3、cardialinfarctionQiaoShubin,GaoRunlin,ChenJilin,etal.CardiovascularInstituteandFuwaiHospitai,PUMC,CAMS,Beijing100037[Abstract]ObjectiveToevaluatetheroleofrescueangioplastyforpatientswithacutemyocardialinfarction(AMT)・MethodsRescueangioplastywasperformedfor36AMTpatients.Fourpatientspresentedink

4、illpclassIIIandIV,and32inKillpclassIandII.Theinfarct-relatedartery(TRA)wasleftanteriordescendingarteryin17,rightcoronaryarteryin14,leftcircumflexin4,intermediatearteryin1.AllpatientshadTIMI0flowbeforePTCAexcept2patientswithTIMIIf1owandtheother2patientswithTIMII-IIflow・PTCAfailedin3patients・PTC

5、Awassuccessfullyperformedin33patients,including13patientswithstentimplantation.ResultsTIMIIIIwasachievedin31patients,TIMIIItoIIIflowin2patients.Soproceduralsuccessratewas91.7%.InhospitalcomplicationsincludedthatonediedofrefractorycardiogenicshockandVfonthesamedayofPTCA・Mortalityratewas5.6%.The

6、rewere14patientswhowererepeatedlyperformedwithcoronaryangiographywithintwomonthsandonly2patientshadrestenosis・ConclusionForAMIpatientswhofailedtoresponsetothrombolysis,rescuePTCAisthealternative・ResultsofourearlyexperieneeinrescuePTCAinasmallpopulationdemonstratedhighproceduralsuccessrate・Resc

7、uePTCAmaybebenefitialtotheshort-termandlong-termoutcomeofpatientswithAML［Keywords】myocardialinfarctionangioplasty,transluminal,percutaneouscoronary急性心肌梗塞（AMI）经静脉溶栓后仍有25%~40%的患者的梗塞相关动脉（IRA）呈完全闭塞。已有研究表明：溶栓后90分钟IRA通畅的患者，其近期及远期预后均好于IRA闭塞的患者