急性心肌梗死伴心衰、心源性休克病人经皮冠状动脉介入治疗近中期疗效

摘要/Abstract

摘要： 目的观察ST段抬高急性心肌梗死(AMI)伴心衰、心源性休克患者经皮冠状动脉介入治疗(PCI)的近期、中期疗效。方法总结分析206例ST抬高AMI患者的临床资料,其中伴心衰和/或休克90例。对心衰或/和心源性休克患者行PCI58例(PCI组:急诊PCI41例,外院转入行补救性PCI17例),药物溶栓20例(溶栓组),一般治疗12例(未行再灌注组);分析各组患者的临床特征,并比较PCI组及溶栓组的住院时间、住院及随访期间不良心血管事件发生率、心功能恢复情况,观察PCI组血管开通时间、TIMI血流与预后的关系。结果 PCI组、溶栓组血管开通率分别为98.3%和65.0%(P<0.01),平均住院时间分别为(15.3±3.5)d和(20.5±4.4)d,住院及随访期间死亡率PCI组6.9%,溶栓组25%(P<0.05)。PCI组两亚组术后心功能恢复均好于溶栓组(P<0.01和P<0.05)。结论对于ST段抬高AMI伴心衰、心源性休克患者,PCI与溶栓相比,能及时开通血管且开通率高,术后近期及中期心功能恢复较好,不良心血管事件少,是一种安全有效的治疗措施,可作为首选。

Abstract: Objective To observe the short- and mid-term effects of percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (AMI) complicated by heart failureandl or cardiogenic shock. Methods Altogether 90 patients with AMI were recruited, of whom 58 were treated by PCI, 20 by thrombolytic therapy, and the other received general treatment without reperfusion therapy. The length of hospital stay, major adverse cardiac events (MACE) and left ventricular ejection fraction (LVEF) were compared between PCI and thrombolysis groups. The relationship between the patency time of the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) grade after PCI and prognosis were analyzed in PCI group. Results The patency rate of IRA was significantly improved in patients receiving PCI therapy in comparison by those with thrombolytic therapy (98.3% vs 65.0%, P<0.01), and the LVEF was also higher in PCI group with lower mortality (6.9% vs 25.0%, P<0.05) during in-hospital and follow-up period. Conclusion PCI can be a more effective therapy than thrombolytic therapy in the treatment of ST-segment elevation AMI companied with heart failureandl or cardio- genic shock.

中图分类号:

R542.22

王同汉, 刘映峰, 李志梁, 魏向龙, 石向东. 急性心肌梗死伴心衰、心源性休克病人经皮冠状动脉介入治疗近中期疗效[J]. 南方医科大学学报, 2005, 25(08): 1064-1066.

WANG Tong-han, LIU Ying-feng, LI Zhi-liang, WEI Xiang-long, SHI Xiang-dong. Observation of short- and mid-term clinical outcome of percutaneous coronary intervention for acute myocardial infarction with heart failure or cardiogenic shock[J]. Journal of Southern Medical University, 2005, 25(08): 1064-1066.

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