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目的 :观察急诊经皮腔内冠状动脉成形术 (PTCA)治疗急性心肌梗死 (AMI)的效果。方法 :13例 AMI患者行急诊 PTCA治疗 ,男 10例 ,女 3例 ,年龄 38～ 85 (6 0 .2± 13.6 )岁。其中 6例并发心源性休克 ,3例系溶栓失败后行补救性 PTCA,4例不适作溶栓治疗。梗死相关血管 :前降支 9例 ,右冠状动脉 4例。结果 :PTCA成功率92 .3% ,死亡 1例。术前梗死相关血管狭窄 (98.7± 3.0 ) % ,术后残余狭窄为 (14.6± 16 .2 ) %。 3例术中发生心室颤动 ,1例出现房室传导阻滞 ,1例出现无再流现象 ,经反复冠状动脉内注射硝酸甘油后恢复。术后 1例死亡 ,11例长期生存 ,随访 1～ 18个月无心脏事件发生 ,生活质量明显改善。结论 :AMI时行急诊 PTCA成功率高 ,对溶栓禁忌证、溶栓失败或 AMI并发心源性休克者应积极行急诊 PTCA。
Objective: To observe the effect of emergency percutaneous transluminal coronary angioplasty (PTCA) on acute myocardial infarction (AMI). Methods Thirteen AMI patients underwent emergency PTCA. There were 10 males and 3 females, aged 38-85 years (60.2 ± 13.6 years). Six cases were complicated by cardiogenic shock, and three cases were given rescue PTCA after failed thrombolytic therapy. Four cases were unsuitable for thrombolytic therapy. Related vessels in infarction: anterior descending artery in 9 cases and right coronary artery in 4 cases. Results: The success rate of PTCA was 92.3%, and 1 patient died. Preoperative infarction-related vascular stenosis (98.7 ± 3.0)%, postoperative residual stenosis (14.6 ± 16.2%). Ventricular fibrillation occurred in 3 cases, atrioventricular block was found in 1 case, no reflow occurred in 1 case and was recovered after repeated intracoronary injection of nitroglycerin. One patient died and 11 had long-term survival. No follow-up of one to 18 months had a cardiac event, and the quality of life improved significantly. Conclusion: The success rate of emergency PTCA during AMI is high. Emergency PTCA should be actively performed on contraindications of thrombolysis, thrombolysis failure or AMI complicated with cardiogenic shock.