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急性心肌梗塞直接经皮冠状动脉腔内成形术 |
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陈方 贾三庆 胡大一 王乐丰 李田昌 杨明 崔亮 魏妤 顼志敏
【摘要】 目的 观察急性心肌梗塞(AMI)患者应用直接经皮冠状动脉腔内成形术(PTCA)的安全性和有效性。方法 对114例AMI患者在发病12小时内行直接PTCA术，其中有5例心原性休克的患者。梗塞相关血管(共115支血管)：左主干3例(2.6%)，前降支56例(48.7%)，回旋支12例(10.4%)，右冠状动脉44例(38.5%)。TIMI血流：0级82例(71.3%)，1级17例(14.7%)，2级16例(14.0%)。 结果 111例患者手术成功，TIMI血流3级(97.4%)。住院期间死亡3例(2.6%)，均为心原性休克患者，其中2例经紧急冠状动脉旁路移植术后死亡。85例患者置入了冠状动脉内支架(73.9%)。随访95例患者，2例后期死于心力衰竭，9例出院后出现心肌缺血，其中8例再次行PTCA术。结论 直接PTCA是治疗急性心肌梗塞的安全有效措施，成功率较高，并发症少；术后复发心肌缺血发生率较溶栓治疗低。
【关键词】 心肌梗塞 血管成形术，经腔，经皮冠状动脉
Direct percutaneous transluminal coronary angioplasty experience in acute myocardial infarction CHEN Fang, JIA Sanqing, HU Dayi, et al. Cardiovascular Institute, Beijing Red Cross Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020
【Abstract】 Objective To evaluate the efficiency and safety of direct angioplasty in acute myocardial infarction (AMI) patients. Methods Direct angioplasty was performed in 114 patients within 12 hours from onset. Single vessel disease was in 66 patients (57.9%), double vessel disease in 28 (24.6%) and triple vessel disease in 20 (17.6%). Infarct-relatedarteries (IRA) were left main in 3 (2.6%), left anterior descending artery in 56(48.7%), left circumflex in 12 (10.4%), right coronary artery in 44 (38.5%). Thrombolysis in myocardial infarction (TIMI) 0 flow was in 82 (71.3%), TIMI 1 flow in 26 (22.7%), TIMI 2 flow in 16 (14.7%). Five patients suffered from cardiac shock and 6 patients were performed intraaortic balloon pump (IABP). Results Procedure success was 111 cases (successful rate 97.4%) and all of them were gained TIMI 3 flow. Three patients died of cardiac shock in hospital and 2 of them died during emergent CABG because of failure angioplasty procedure. The coronary stent were implanted in 85 patients (73.9%). With following up 95 patients, 2 patients died of congestive heart failure, 9 patients occurred recurrent ischemia and 8 of them were revascularized. Conclusion Direct angiopl[1] [2] 下一页
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