论文部分内容阅读
目的 对急性心肌梗死 (AMI)直接经皮冠状动脉成形术 (P PTCA)治疗的疗效进行评价。方法 1 996年 1 0月至 1 999年 1 2月 ,我们对 32 8例AMI患者进行了全天候P PTCA术 ,对部分病例的疗效与静脉溶栓治疗进行了对比 ,对多数病例进行了院内和院外随访。结果 梗死相关血管 (IRA)再通率 96 3% ,其中TIMI 3级血流占 98 2 % ,明显高于溶栓治疗 50 %～ 70 %的再通率 ,住院死亡率为 3% ,死亡患者均伴有心源性休克。病人从急诊室到导管室开始动脉穿刺的时间 (doortoneedle)为 30分钟左右。局部血肿 4% ,大出血 2例 (0 6 % )。随访病人 2 96人 ,平均随访2 1个月 (1～ 42个月 ) ,后期死亡 4例 ,均死于充血性心力衰竭。复发缺血病人 (复发心绞痛并伴有心电图缺血性改变 ) 34例 (1 0 8% ) ,6例 (0 1 9% )发生再梗死 ,均重复PTCA术 ,1 0 2例 (31 1 % )病人因多支血管病变而进行再次择期PTCA或冠脉旁路移植术。结论 直接PTCA是抢救急性心肌梗死、改善远期预后的有效方法。
Objective To evaluate the efficacy of direct percutaneous transluminal coronary angioplasty (P PTCA) in patients with acute myocardial infarction (AMI). Methods From January 1996 to January 1999, we performed all-weather P PTCA in 32 8 patients with AMI. The curative effect of some patients was compared with that of intravenous thrombolysis. Most of the patients were hospitalized and Hospital follow-up. Results The recanalization rate of IRA was 96.3%. The TIMI grade 3 blood flow accounted for 98.2%, significantly higher than the 50% -70% recanalization rate of thrombolytic therapy, and the in-hospital mortality was 3% A cardiogenic shock. The patient’s time to start an arterial puncture from the emergency department to the catheterization is about 30 minutes. Local hematoma 4%, bleeding in 2 cases (0 6%). A total of 2 96 patients were followed up, with a mean follow-up of 21 months (ranging from 1 to 42 months) and 4 late deaths, all of whom died of congestive heart failure. Among the patients with recurrent ischemic stroke (recurrent angina with ischemic ECG changes), 34 cases (108%) and 6 cases (019% ) Patients underwent repeat elective PTCA or coronary artery bypass grafting due to multivessel disease. Conclusions Direct PTCA is an effective method to rescue acute myocardial infarction and improve long-term prognosis.