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急性心肌梗死合并心源性休克患者冠脉病变特点及再灌注疗法的效果 |
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马淑 郝恒剑 胡大一 顼志敏 贾三庆 王文茂 张全发
【摘 要】 目的 探讨急性心肌梗死(AMI)合并心源性休克患者的冠脉病 变特点及再灌注疗法的效果。方法 以74例AMI患者为对象，按是否合并心源性休克分为休克组16例，非 休克组58例，对比两组患者的临床资料，冠脉造影及再灌注疗法对预后的影响。结果 休克组院内病死率显著高于非休克组(P＜0.05)；休克组各种并发症比例均显著高于 非休克组，其中梗死延展休克组发生率为38%，非休克组为5%(P＜0.01)；冠脉造影显 示，休克组3支病变显著高于非休克组(P＜0.01)，前者99%以上的严重狭窄病变多、钙 化严重及侧支循环发育不良。再灌注治疗后，梗死相关冠脉再通率休克组显著低于非休克组 (P＜0.05)，休克组院内病死率受梗死相关冠脉再通与否的影响，再通的6例仅1例死亡 ，而未再通的5例3例死亡。结论 AMI合并心源性休克患者，冠脉病变严重、复杂，病死率高，改善预 后的关键是恢复再灌注及预防梗死延展。
【关键词】 急性心肌梗死 心源性休克 再灌注疗法
Coronary angiographic findings and effects of reperfusion therap ies in acute myocardial infarction with cardiogenic shock
Ma shu,Hao Hengjian,Hu Dayi,et al.
(Cardiology Department,B eijing Tongren Hospital,Beijing 100730)
【Abstract】 Objective To investigate coronar y angiographic findings and the effect of reperfusion therapies in patients with acute myocardial infarction(AMI)complicated with shock.Methods 16 shock patients and 58 patients without shock were comparatively studied to observe clinical characteristics,coronary angiogra phic findings and the effects of reperfusion therapies on prognosis. Results In shock group,the in-hospital morta lity rate was significantly higher than that without shock(25% vs 5%,P<0.05 ).Frequency of various severe complications were significantly higher in the for mer than the latter.The occurrence of “extension”was 38% in shock group,it was significantly higher than that without shock(P<0.01).Coronary angiographic findings revealed that extensive three-vessel disease was a more common finding in patients with shock than those without(53% vs 8%,P<0.01).Other angiogra phic findings,such as the ≥99% stenosis,more severe calcification and poor deve lopment of collaterals to the infarct-related artery(IRA),were more in shock ca ses(P<0.01).Success rate after reperfusion therapies was significantly lowe r in shock group than that without shock(55% vs 86%,P<0.05).Concerning thes e[1] [2] 下一页
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