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急性心肌梗死静脉溶栓后急诊补救性PTCA+支架术的临床评价(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第2期
页码:
147-148
栏目:
临床研究
出版日期:
2005-03-05

文章信息/Info

Title:
The clinical evaluatian of rescue emergency PTCA+stenting following thrombolytic therapy in acute myocardial infarction
作者:
高华1; 张志寿2; 张华3
1.山西吕梁荣军医院，山西 离石 033000；2.解放军总医院，北京 100853；3. 北京医星医院,北京 100071
Author(s):
GAO Hua1; ZHANG Zhishou2; ZHANG Hua3
1. Department of cardiology, Shanxi Lvliang Rongjun Hospital, Lishi,Shanxi 033000, China
关键词:
心肌梗塞; 急性;  静脉溶栓;  支架术
Keywords:
myocardial infarction; acute;  thrombolytic therapy;  stenting
分类号:
R542.22
DOI:
-
文献标识码:
A
摘要:
目的 观察急性心肌梗死(AMI)静脉溶栓后仍有胸痛或血流动力学不稳定、急性左心功能不全以及心律失常、病态窦房结综合征（SSS）、Ⅲ°AVB、阵发性室速等状态下，紧急行PTCA +支架术对抢救患者的生命的疗效及安全性。方法 12例AMI患者均在外院行尿激酶溶栓后，心电图无变化，仍伴有胸痛、低血压、心源性休克、SSS、心动过缓、Ⅲ°AVB、阵发性室速、左心功能不全等其中一项或多项，在24 h内紧急行PTCA+支架治疗。介入治疗术前及术后观察患者的症状、心率、血压，应用超声心动图测心室功能的动态变化情况。结果 5例胸痛患者通过PTCA+支架术后，胸痛完全消失，2例术前伴有心源性休克及左心功能不全的患者术后6 h血压比术前明显升高，术后心率明显减慢，12 h超声心动图测心室功能明显改善，5例伴有心动过缓及低血压患者术后6 h血压显著升高，心率较术前明显提高。结论 AMI静脉溶栓后仍有血流动力学不稳定的状态下，治疗的关键是尽早使完全或近似完全梗死的血管再通，行急诊补救性PTCA+支架是十分有效和较为安全的方法。
Abstract:
AIM To observe the safty and efficiency of rescue emergency PTCA+stenting following thrombolytic therapy in acute myocardial infarction(AMI) with angina, invariable ECG,unstable hemodynamics,acute left ventricular failure, cardiac arrhythmias (SSS, Ⅲ°AVB,VT). METHODS 12 patients with AMI underwent intravenous thrombolytic outhospital, however, of whom had invariable ECG,angina,hypotension,cardiogenic shock, bradycardia, SSS, Ⅲ°AVB,VT, left ventricular failure,All of cases undervent rescue emergency PTCA+stenting within 12 hours after AMI and changes of symptom,BP,HR were observed,especially left ventricle ejection fraction (LVEF) was evaluated by echocardiograph between preoperated and postoperated. RESULTS The angina in 5 cases was completely alleviated after operation.The cardiogenic shock and the left ventricular failure in 2 cases was improved obviously, result in inprovement of BP,HR,LVEF within 6 hours after operation.The BP and HR raise in 5 cases with bradycardia and/or hypotension. CONCLUSION It's important in AMI following thrombolytic with unstable hemodynamics to reopen infarction relative artery.The rescue emergency PTCA+stenting following thrombolytic therapy is a rational,safety and efficient,The patient in AMI following thrombolytic therapy with unstable hemodynamics is easy accompany with acute left ventricular failure or cardiogenic shock, whose mortality is high.

参考文献/References

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［2］马长生. 老年冠心病介入治疗的评价［J］ . 中华老年多器官疾病杂志，2003,2:14.

［3］Ellis SG, Ribero da SE,Heyndrickx G, et al. Randomized comparison of rescue angioplasty with conservative management of paitients with early failure of acute anterior myocardial infarction［J］. Circulation，1994,90:2280-2284.

［4］周国伟，何奔，松宝贵. 急性心肌梗死溶栓后介入治疗的现状［J］.中国介入心脏病学杂志，2002,10:162-163.

［5］杨丽霞，齐峰，王先梅,等. 经皮冠状动脉介入治疗对心肌梗死患者心功能的影响［J］. 心脏杂志，2004,16（4）:329-331.

备注/Memo

备注/Memo:
收稿日期：2004-06-09.
更新日期/Last Update: 2010-01-05