急诊经皮冠状动脉腔内成形术治疗急性心肌梗死的临床价值(1)
【摘要】 目的探讨急诊经皮冠状动脉腔内成形术(PTCA)治疗急性心肌梗死的临床价值。方法 对48例急性心肌梗死患者在发病后12 h内进行急诊PTCA，术后即刻行血管造影并进行随访(6～12个月)观察，评价其疗效。结果 48例患者共扩张57支血管，其中左前降支36支，左回旋支12支，右冠状动脉9支；完全闭塞性病变24支, 成功率为75.0%(18/24)，而不完全闭塞性病变33支，成功率97.0%(32/33)(P<0.05)。随访6～12个月，40例(83.3%)无靶血管再狭窄及与其相关的心绞痛、心肌梗死，8例(16.7%)因靶血管再狭窄而进行支架植入治疗。结论 急诊PTCA治疗急性心肌梗死近期疗效显著，值得临床进一步推广。
【关键词】血管成形术；经腔、经皮冠状动脉；急性心肌梗死；急诊
The clinical value of percutaneous tranluminal coronary angioplasty in acute myocardial infarction
, http://www.100md.com
WANG Jian, ZHAO Zhen-tao, YUE Yuan.
Center of the First-Aid, the Second Affiliated Hospital, Shandong Medical University of TCM,Jinan ,Shandong 250001，China
【Abstract】 ObjectiveTo investigate the clinical value of percutaneous tranluminal coronary angioplasty(PTCA) in acute myocardial infarction. MethodsPTCA was performed with 48 patients with acute myocardial infarction within 12 h, and postoperative instantly angiography, follow-up from 6 months to 12 months were carried out to evaluate its therapeutic effect. ResultsAmong 48 patients, 57 ramus arteries were expanded, including left anterior descending branch 36 ramus, left circumflex branch 12 ramus, right coronary artery 9 ramus; Achievement ratio of fully obliterans lesion 24 ramus(18/24) was 75.0%, but non-fully obliterans lesion 33 ramus was 97.0%(32/33), there was significant difference in achievement ratio of PTCA between fully obliterans lesion and non-fully obliterans lesion(P<0.05).During follow-up (6 months to 12 months), 40 cases(83.3%) had not restenosis of target vessel, correlative angina pectoris,and myocardial infarction; 8 cases(16.7%) received stents implantation because of the restenosis of target vessel.ConclusionEmergency PTCA has markedly therapeutic effect in the near future in in acute myocardial infarction, and be worthy of being further spreaded.
, 百拇医药
【Key words】Acute myocardial infarction;Angioplasty, transluminal percutaneous coronary;Acute myocardial infarction; Emergency
急性心肌梗死(AMI)治疗的关键是及时、有效地开通梗死相关血管，实现心肌再灌注[1]。目前实现心肌再灌注的方法包括静脉溶栓治疗和急诊介入治疗。静脉溶栓治疗简便、易行，但溶栓后冠脉开通率仅为70%左右、且恢复再灌注时间较长；而急诊冠状动脉介入治疗的冠脉开通率可达90%～95%，可快速恢复冠脉再灌注，尤其可显著降低心源性休克患者的病死率[2]。因此，急诊冠状动脉介入治疗目前已成为急性心肌梗死治疗的主要方法。本院近年来对48例急性心肌梗死患者进行急诊经皮腔内冠状动脉成形术取得了满意疗效，现报告如下。
, http://www.100md.com
1 资料与方法
1.1 一般资料 2005年8月至2008年4月间本院急诊科对48例急性心肌梗死患者进行了急诊经皮冠状动脉腔内成形术，所有入选病例均符合以下标准：①急起胸骨后压榨样疼痛≥30 min，休息或舌下含服硝酸甘油不缓解；②ECG显示相邻两个导联ST段弓背向上抬高，且肢体导联>0.1 mV、胸导联>0.2 mV；③血清肌酸激酶等心肌酶谱升高；④起病至就诊的时间≤12 h；⑤经静脉溶栓90 min内仍持续胸痛或ST段仍抬高者。其中男29例，女19例，年龄44～72岁，平均53.5岁。ECG显示心肌梗死的部位：前壁 13例，前间壁15例，广泛性前壁 8例，下壁7例，下壁+后壁5 例。急诊冠状动脉造影显示：单支血管病变33例，双支血管病变 10例，3支血管病变5例；病变相关血管：前降支32例，回旋支8例，右冠脉8例。心脏功能分级：心功能Ⅰ～Ⅱ级34例，Ⅲ级8例，Ⅳ级6例。血清胆固醇>5.85 mmol/L 13例，血清三酰甘油>1.8 mmol/L 21例，血清胆固醇和三酰甘油均高于正常8例。
, 百拇医药
1.2 治疗方法
1.2.1 术前准备 血、尿、粪常规，出、凝血时间，以及肝、肾功能检查；胸部X线摄影，心脏超声。禁食4 h，手术当日不停用治疗心绞痛的药物。手术野皮肤准备，拟行支架植入的患者术前1天口服盐酸噻氯匹定250 mg，2次/d，同时口服阿司匹林300 mg。
1.2.2 介入操作 采用Sedinger法穿刺右侧或左侧股动脉，放置8 F鞘管，经鞘管注入肝素6000～6500 U。冠脉造影确定梗死相关血管后，选用8 F大腔导引导管和0.365 mm导引导丝，根据靶血管的大小选用相应的球囊导管(球囊直径/血管直径≈1∶1.1)。球囊到达病变部位后，以101.35～405.30 kPa扩张球囊1～5次，每次30～200 s，造影复查达到满意疗效后退出球囊。
, http://www.100md.com(王 健 赵振涛 岳 园)
【关键词】血管成形术；经腔、经皮冠状动脉；急性心肌梗死；急诊
The clinical value of percutaneous tranluminal coronary angioplasty in acute myocardial infarction
, http://www.100md.com
WANG Jian, ZHAO Zhen-tao, YUE Yuan.
Center of the First-Aid, the Second Affiliated Hospital, Shandong Medical University of TCM,Jinan ,Shandong 250001，China
【Abstract】 ObjectiveTo investigate the clinical value of percutaneous tranluminal coronary angioplasty(PTCA) in acute myocardial infarction. MethodsPTCA was performed with 48 patients with acute myocardial infarction within 12 h, and postoperative instantly angiography, follow-up from 6 months to 12 months were carried out to evaluate its therapeutic effect. ResultsAmong 48 patients, 57 ramus arteries were expanded, including left anterior descending branch 36 ramus, left circumflex branch 12 ramus, right coronary artery 9 ramus; Achievement ratio of fully obliterans lesion 24 ramus(18/24) was 75.0%, but non-fully obliterans lesion 33 ramus was 97.0%(32/33), there was significant difference in achievement ratio of PTCA between fully obliterans lesion and non-fully obliterans lesion(P<0.05).During follow-up (6 months to 12 months), 40 cases(83.3%) had not restenosis of target vessel, correlative angina pectoris,and myocardial infarction; 8 cases(16.7%) received stents implantation because of the restenosis of target vessel.ConclusionEmergency PTCA has markedly therapeutic effect in the near future in in acute myocardial infarction, and be worthy of being further spreaded.
, 百拇医药
【Key words】Acute myocardial infarction;Angioplasty, transluminal percutaneous coronary;Acute myocardial infarction; Emergency
急性心肌梗死(AMI)治疗的关键是及时、有效地开通梗死相关血管，实现心肌再灌注[1]。目前实现心肌再灌注的方法包括静脉溶栓治疗和急诊介入治疗。静脉溶栓治疗简便、易行，但溶栓后冠脉开通率仅为70%左右、且恢复再灌注时间较长；而急诊冠状动脉介入治疗的冠脉开通率可达90%～95%，可快速恢复冠脉再灌注，尤其可显著降低心源性休克患者的病死率[2]。因此，急诊冠状动脉介入治疗目前已成为急性心肌梗死治疗的主要方法。本院近年来对48例急性心肌梗死患者进行急诊经皮腔内冠状动脉成形术取得了满意疗效，现报告如下。
, http://www.100md.com
1 资料与方法
1.1 一般资料 2005年8月至2008年4月间本院急诊科对48例急性心肌梗死患者进行了急诊经皮冠状动脉腔内成形术，所有入选病例均符合以下标准：①急起胸骨后压榨样疼痛≥30 min，休息或舌下含服硝酸甘油不缓解；②ECG显示相邻两个导联ST段弓背向上抬高，且肢体导联>0.1 mV、胸导联>0.2 mV；③血清肌酸激酶等心肌酶谱升高；④起病至就诊的时间≤12 h；⑤经静脉溶栓90 min内仍持续胸痛或ST段仍抬高者。其中男29例，女19例，年龄44～72岁，平均53.5岁。ECG显示心肌梗死的部位：前壁 13例，前间壁15例，广泛性前壁 8例，下壁7例，下壁+后壁5 例。急诊冠状动脉造影显示：单支血管病变33例，双支血管病变 10例，3支血管病变5例；病变相关血管：前降支32例，回旋支8例，右冠脉8例。心脏功能分级：心功能Ⅰ～Ⅱ级34例，Ⅲ级8例，Ⅳ级6例。血清胆固醇>5.85 mmol/L 13例，血清三酰甘油>1.8 mmol/L 21例，血清胆固醇和三酰甘油均高于正常8例。
, 百拇医药
1.2 治疗方法
1.2.1 术前准备 血、尿、粪常规，出、凝血时间，以及肝、肾功能检查；胸部X线摄影，心脏超声。禁食4 h，手术当日不停用治疗心绞痛的药物。手术野皮肤准备，拟行支架植入的患者术前1天口服盐酸噻氯匹定250 mg，2次/d，同时口服阿司匹林300 mg。
1.2.2 介入操作 采用Sedinger法穿刺右侧或左侧股动脉，放置8 F鞘管，经鞘管注入肝素6000～6500 U。冠脉造影确定梗死相关血管后，选用8 F大腔导引导管和0.365 mm导引导丝，根据靶血管的大小选用相应的球囊导管(球囊直径/血管直径≈1∶1.1)。球囊到达病变部位后，以101.35～405.30 kPa扩张球囊1～5次，每次30～200 s，造影复查达到满意疗效后退出球囊。
, http://www.100md.com(王 健 赵振涛 岳 园)