无主动脉内球囊反搏辅助的急诊经皮冠状动脉腔内成形术治疗急性心肌梗塞合并心源性休克(摘要)
作者：葛永贵 张群林 王家宁 王玮 党书毅 王崇全 许大国 张绪国
单位：湖北省，十堰市太和医院 心内科(442000)
关键词：
中国循环杂志99zk26 目的：我们在无主动脉内球囊反搏(IABP)辅助下采用急诊经皮冠状动脉腔内成形术(PTCA)治疗6例急性心肌梗塞合并心源性休克。
方法：1996年11月至1999年6月在我院住院的急性心肌梗塞合并心源性休克的病人共6例，年龄66.0±13.3(48～85)岁。心源性休克诊断标准：在用正性肌力药物的情况下收缩压低于80 mmHg(1 mmHg=0.133 kPa)伴明显末梢灌注不足表现。6例病人中前侧壁心肌梗塞4例，下后壁心肌梗塞2例，其中3支病变3例、2支病变2例、单支病变1例。所有病人均在发生心源性休克表现后2小时内对梗塞相关血管进行PTCA，均无IABP辅助。直接PTCA 4例，溶栓失败后挽救性PTCA 2例。支架置入标准：明显冠状动脉内膜撕裂，残余狭窄>50%或者梗塞相关血管前向血流未达到心肌梗塞溶栓治疗临床试验(TIMI)血流3级。
, 百拇医药
结果：PTCA成功5例(83.3%)。3例病人置入4个冠状动脉内支架。发生心源性休克症状至梗塞相关血管再通时间在3小时内。1例病人在入院后1小时内死于PTCA术中。在PTCA成功的5例病人中休克均被逆转。1例85岁女性患者住院5天后自动出院放弃治疗。2天后死于家中，其余4例病人住院期间无心绞痛、严重心律失常、再梗塞以及再次介入治疗时，随访6～27个月，该4例病人长期存活。
结论：虽然IABP结合急诊PTCA能进一步提高急性心肌梗塞合并心源性休克病人的存活率。在无IABP的辅助下，只要及时识别心源性休克表现，尽早开通梗塞相关血管，同样可降低死亡率，且手术成功率高。
Emergent Percutaneous Transluminal Coronary Angioplasty without Intra-Aortic Balloon Pumping Support in Acute Myocardial Infarction Complicated with Cardiogenic Shock (Abstract)
, 百拇医药
Department of Cardiology, Taihe Hospital, Shiyan (442000), Hubei
Ge Yonggui, Zhang Qunlin, Wang Jianing, et al.
Objective: We report clinical efficacy of 6 patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) treated by emergent percutaneous transluminal coronary angioplasty (PTCA) without intra-aortic balloon pumping (IABP) support.
Methods: From November 1996 until June 1999, six patients admitted to our hospital with AMI complicated with CS underwent emergent coronary angioplasty. The mean age was 66.0±13.3 (38～85) years. Shock was defined as systolic blood pressure (BP)≤80 mmHg with clinicla symptoms of hypoperfusion under inotropic agents support. There were anterio-lateral myocardial infarction in 4 cases, inferio-posterial myocardial infarction in 2 cases, of them triple vessel disease in 3 cases, double vessel disease in 2 and single vessel disease in 1. PTCA was performed within two hours after onset of shock symptoms without IABP support in all patients. Only infarct-related coronary artery (IRCA) was dilated during acute phase. Direct PTCA was done in 4 cases and rescue PTCA after failure of thrombolytic therapy in 2. Stent was implanted for apparent dissection of coronary artery intima, residual stenosis >50% or antegrade blood flow of IRCA less than TIMI 3.
, http://www.100md.com
Results: PTCA was successful in 5 (83.3%) of 6 cases. 4 stents were implanted in 3 patients. The time from onset of shock symptoms to reperfusion of IRCA was less than 3 hours. One patient died during procedure within an hour admitted to hospital. Cardiogenic shock was reverted in 5 patients with successful PTCA. A 85-year-old female patient with successful PTCA auto discharged and died seven days after the procedure. There were no angina, sever arrhythmia, reinfarction and reintervention in remaining 4 cases. During a period of 6～27 months follow-up, long-term survival were obtained in 4 patients.
, 百拇医药
Conclusion: Although IABP combining direct PTCA can improve survival in patients with cardiogenic shock complicating AMI with early pump failure, our initial experiences suggest that recognizing signs of incipient shock and revascularization of IRCA by emergent PTCA as early as possible can achieve a high success rate and significantly decrease the mortality rate in patients with AMI complicated with CS even without IABP support., 百拇医药
单位：湖北省，十堰市太和医院 心内科(442000)
关键词：
中国循环杂志99zk26 目的：我们在无主动脉内球囊反搏(IABP)辅助下采用急诊经皮冠状动脉腔内成形术(PTCA)治疗6例急性心肌梗塞合并心源性休克。
方法：1996年11月至1999年6月在我院住院的急性心肌梗塞合并心源性休克的病人共6例，年龄66.0±13.3(48～85)岁。心源性休克诊断标准：在用正性肌力药物的情况下收缩压低于80 mmHg(1 mmHg=0.133 kPa)伴明显末梢灌注不足表现。6例病人中前侧壁心肌梗塞4例，下后壁心肌梗塞2例，其中3支病变3例、2支病变2例、单支病变1例。所有病人均在发生心源性休克表现后2小时内对梗塞相关血管进行PTCA，均无IABP辅助。直接PTCA 4例，溶栓失败后挽救性PTCA 2例。支架置入标准：明显冠状动脉内膜撕裂，残余狭窄>50%或者梗塞相关血管前向血流未达到心肌梗塞溶栓治疗临床试验(TIMI)血流3级。
, 百拇医药
结果：PTCA成功5例(83.3%)。3例病人置入4个冠状动脉内支架。发生心源性休克症状至梗塞相关血管再通时间在3小时内。1例病人在入院后1小时内死于PTCA术中。在PTCA成功的5例病人中休克均被逆转。1例85岁女性患者住院5天后自动出院放弃治疗。2天后死于家中，其余4例病人住院期间无心绞痛、严重心律失常、再梗塞以及再次介入治疗时，随访6～27个月，该4例病人长期存活。
结论：虽然IABP结合急诊PTCA能进一步提高急性心肌梗塞合并心源性休克病人的存活率。在无IABP的辅助下，只要及时识别心源性休克表现，尽早开通梗塞相关血管，同样可降低死亡率，且手术成功率高。
Emergent Percutaneous Transluminal Coronary Angioplasty without Intra-Aortic Balloon Pumping Support in Acute Myocardial Infarction Complicated with Cardiogenic Shock (Abstract)
, 百拇医药
Department of Cardiology, Taihe Hospital, Shiyan (442000), Hubei
Ge Yonggui, Zhang Qunlin, Wang Jianing, et al.
Objective: We report clinical efficacy of 6 patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) treated by emergent percutaneous transluminal coronary angioplasty (PTCA) without intra-aortic balloon pumping (IABP) support.
Methods: From November 1996 until June 1999, six patients admitted to our hospital with AMI complicated with CS underwent emergent coronary angioplasty. The mean age was 66.0±13.3 (38～85) years. Shock was defined as systolic blood pressure (BP)≤80 mmHg with clinicla symptoms of hypoperfusion under inotropic agents support. There were anterio-lateral myocardial infarction in 4 cases, inferio-posterial myocardial infarction in 2 cases, of them triple vessel disease in 3 cases, double vessel disease in 2 and single vessel disease in 1. PTCA was performed within two hours after onset of shock symptoms without IABP support in all patients. Only infarct-related coronary artery (IRCA) was dilated during acute phase. Direct PTCA was done in 4 cases and rescue PTCA after failure of thrombolytic therapy in 2. Stent was implanted for apparent dissection of coronary artery intima, residual stenosis >50% or antegrade blood flow of IRCA less than TIMI 3.
, http://www.100md.com
Results: PTCA was successful in 5 (83.3%) of 6 cases. 4 stents were implanted in 3 patients. The time from onset of shock symptoms to reperfusion of IRCA was less than 3 hours. One patient died during procedure within an hour admitted to hospital. Cardiogenic shock was reverted in 5 patients with successful PTCA. A 85-year-old female patient with successful PTCA auto discharged and died seven days after the procedure. There were no angina, sever arrhythmia, reinfarction and reintervention in remaining 4 cases. During a period of 6～27 months follow-up, long-term survival were obtained in 4 patients.
, 百拇医药
Conclusion: Although IABP combining direct PTCA can improve survival in patients with cardiogenic shock complicating AMI with early pump failure, our initial experiences suggest that recognizing signs of incipient shock and revascularization of IRCA by emergent PTCA as early as possible can achieve a high success rate and significantly decrease the mortality rate in patients with AMI complicated with CS even without IABP support., 百拇医药