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目的 :观察冠状动脉介入治疗急性心肌梗死的安全性 ,疗效和并发症。方法 :2 0 0 1年 12月 1日至 2 0 0 2年7月 3 1日对 2 4例急性心肌梗死患者在发病 12小时内行冠状动脉介入治疗。男 2 0例 ,女 4例。年龄 48-81岁 (65± 8)。 14例直接行冠脉腔内成行术 (PTCA)和支架术 ,7例系静脉溶栓失败后行PTCA和支架术 ,3例冠脉造影发现不适合行PTCA和支架术而行冠脉内溶栓。 2 4例中有 1例心肺复苏后及 2例心源性休克患者。梗死相关血管 :左前降支 (LAD) 15例 ,旋支 (LCX) 2例 ,右冠脉 7例。TIMI血流 0级 17例 ,1级 7例。结果 :2 4例中 2 1例PTCA后植入支架 2 3枚 ,TIMI血流均达到 3级 ,其中有 2例支架植入时TIMI血流 2级经冠脉内注射异搏定 2 0 0微克及尿激酶(UK) 2 5万单位后达到 3级。发病到梗死相关血管再灌注时间为 2 -13小时 (5 .2± 1.2 )。有 1例用球囊扩张后发现有很多血拴不宜植入支架 ,有 1例进导引导丝时发现血栓向近端增长不宜继续PTCA及支架术 ,有 1例冠脉造影发现LAD起始 10 0 %堵塞与左主干之间无断端也不宜行PTCA和支架术 ,上述 3例均改为冠脉溶栓 ,7天后再造影相关血管均已再通。住院期间 2例心源性休克患者均死亡 ,1例死于PTCA和支架术后无再流 ,推测为远端血栓堵塞 ,1例死于顽固性心力衰竭 ,?
Objective: To observe the safety, efficacy and complications of coronary intervention in the treatment of acute myocardial infarction. METHODS: From December 1, 2001 to July 31, 2002, 24 patients with acute myocardial infarction underwent coronary intervention within 12 hours of onset. 20 males and 4 females. Age 48-81 (65 ± 8). 14 cases underwent direct coronary angioplasty (PTCA) and stenting, 7 cases of failed thrombolysis after PTCA and stenting, 3 cases of coronary angiography was found unsuitable for PTCA and stenting and coronary intracoronary bolt. There were 1 case of cardiopulmonary resuscitation and 2 cases of cardiogenic shock in 24 cases. Infarct-related blood vessels: 15 cases of LAD, 2 cases of LCX and 7 cases of right coronary artery. TIMI grade 0 flow in 17 cases, grade 1 in 7 cases. Results: Twenty-two PTCA patients were treated with 23 stent-grafts in 2 of 24 patients. The TIMI blood flow reached grade 3, of which 2 patients were treated with TIMI flow grade 2 after stent implantation by intravenous injection of verapamil Mice and urokinase (UK) 25 million units reached 3. The onset of infarction-related vascular reperfusion time was 2 -13 hours (5.2 ± 1.2). 1 case of balloon dilatation and found that there are many blood tied should not be implanted stent, 1 case into the guide wire found proximal to the growth of thrombus should not continue PTCA and stenting, a case of coronary angiography found LAD 10 0% blockage and no interruption between the left main trunk PTCA and stenting should not be performed, the above three cases were replaced by coronary thrombolysis, and then 7 days after angiography related blood vessels have been recanalized. During the hospitalization, 2 patients died of cardiogenic shock, 1 died of PTCA and no recurrence after stenting, suggesting that distal thrombus was blocked and 1 patient died of refractory heart failure.