急性心肌梗塞经皮冠状动脉腔内支架术(摘要)
作者：赵驰 汪浩 董剑 张静 智永超
单位：辽宁省，大连市中心医院 心内科(115000)
关键词：
中国循环杂志99zk45 目的：冠状动脉支架置入用于急性心肌梗塞可以减少急诊经皮冠状动脉腔内成形术(PTCA)并发症的发生，提高PTCA的成功率，减少再狭窄的发生率。
方法：我院自1995年8月至1999年3月对急性心肌梗塞患者36例做了急诊PTCA术，其中有11例患者球囊扩张不满意而置入冠状动脉内支架，占同期急诊PTCA治疗患者的30.6%,其中男性8例，女性3例，年龄35～72岁，平均57.5±14.5岁。
结果：置入支架的11例患者，其中Palmaz-Schatz支架1例，CORDIS支架3例，XT支架7例。置入支架的原因，有8例因球囊扩张后仍不满意，残余狭窄较重，多为弹性回缩所致。有3例为内膜剥脱。11例患者术后随访2～40个月，3个月发生急性心肌梗塞1例，再次急诊冠状动脉造影，发现支架内血栓形成而闭塞，于支架内球囊扩张成功。置入支架的11例患者术后残余狭窄为<20%。
结论：急诊PTCA时因血管开通不满意，采取冠状动脉内支架置入是有效且可行的，但一定要掌握适应证，判定好病变血管的直径，否则会增加术中或术后的并发症。
Coronary Interventional Therapy in Acute Myocardial Infarction (Abstract)
Department of Cardiology, Dalian Central Hospital, Dalian (115000), Liaoning
Zhao Chi, Wang Hao, Dong Jian, et al.
Objective: Percutaneous transluminal coronary angioplasty (PTCA) has been considered more and more an alternative other than coronary thrombolytic treatment (CTT) of acute myocardial infarction (AMI).
Methods: Primary treatment with immediate CTT or PTCA of the infarct vessel was performed on 41 patients (36 males, 5 females, mean age 59.9 years) with AMI. CTT was judged successful if the infarct vessel was reopened to perfusion grade 2 or 3, and PTCA was judged successful if the infarct vessel was reopened to perfusion grade 3 and the restenosis was <50%. Heparin infusion was given during and 24～48 hours after the procedure. One patient was treated with relaxing spasm treatment, and the occluded vessel was reopened.
Results: The primary success rate of CTT for 16 patients was 68.7% (11 of 16 patients), the average stenosis before the treatment was 96.9%, after the treatment was 75.99%. The primary success rate of PTCA for 25 patients was 88% (22 of 25 patients). The stenosis before PTCA was 99.95%, after PTCA was 29%. Four of 25 patients were treated with stents. Two of 25 patients fell in shock or required resuscitation, and then one of them died (death rate 50%).
Conclusion: Prompt coronary intervention right after acute myocardial infarction onset is the key to high primary success rate., 百拇医药
单位：辽宁省，大连市中心医院 心内科(115000)
关键词：
中国循环杂志99zk45 目的：冠状动脉支架置入用于急性心肌梗塞可以减少急诊经皮冠状动脉腔内成形术(PTCA)并发症的发生，提高PTCA的成功率，减少再狭窄的发生率。
方法：我院自1995年8月至1999年3月对急性心肌梗塞患者36例做了急诊PTCA术，其中有11例患者球囊扩张不满意而置入冠状动脉内支架，占同期急诊PTCA治疗患者的30.6%,其中男性8例，女性3例，年龄35～72岁，平均57.5±14.5岁。
结果：置入支架的11例患者，其中Palmaz-Schatz支架1例，CORDIS支架3例，XT支架7例。置入支架的原因，有8例因球囊扩张后仍不满意，残余狭窄较重，多为弹性回缩所致。有3例为内膜剥脱。11例患者术后随访2～40个月，3个月发生急性心肌梗塞1例，再次急诊冠状动脉造影，发现支架内血栓形成而闭塞，于支架内球囊扩张成功。置入支架的11例患者术后残余狭窄为<20%。
结论：急诊PTCA时因血管开通不满意，采取冠状动脉内支架置入是有效且可行的，但一定要掌握适应证，判定好病变血管的直径，否则会增加术中或术后的并发症。
Coronary Interventional Therapy in Acute Myocardial Infarction (Abstract)
Department of Cardiology, Dalian Central Hospital, Dalian (115000), Liaoning
Zhao Chi, Wang Hao, Dong Jian, et al.
Objective: Percutaneous transluminal coronary angioplasty (PTCA) has been considered more and more an alternative other than coronary thrombolytic treatment (CTT) of acute myocardial infarction (AMI).
Methods: Primary treatment with immediate CTT or PTCA of the infarct vessel was performed on 41 patients (36 males, 5 females, mean age 59.9 years) with AMI. CTT was judged successful if the infarct vessel was reopened to perfusion grade 2 or 3, and PTCA was judged successful if the infarct vessel was reopened to perfusion grade 3 and the restenosis was <50%. Heparin infusion was given during and 24～48 hours after the procedure. One patient was treated with relaxing spasm treatment, and the occluded vessel was reopened.
Results: The primary success rate of CTT for 16 patients was 68.7% (11 of 16 patients), the average stenosis before the treatment was 96.9%, after the treatment was 75.99%. The primary success rate of PTCA for 25 patients was 88% (22 of 25 patients). The stenosis before PTCA was 99.95%, after PTCA was 29%. Four of 25 patients were treated with stents. Two of 25 patients fell in shock or required resuscitation, and then one of them died (death rate 50%).
Conclusion: Prompt coronary intervention right after acute myocardial infarction onset is the key to high primary success rate., 百拇医药