论文部分内容阅读
目的了解PCI术后24 h内急性左心功能衰竭(AHF)的发病率,分析临床特点和相关危险因素。方法回顾分析我科自1997年1月至2006年12月行PCI术1 565例患者的临床资料,根据AHF特征性症状和体征如咳嗽、咳粉红色泡沫样痰、气促、心悸、脉搏细速、大汗淋漓、面色苍白、皮肤湿冷、末梢发绀、心动过速、奔马律、双肺干湿性哕音肺(泡)间质水肿、低血压或血压显著升高、谵妄及少尿等．尽早进行床边心脏超声检查评估心室功能及辦膜功能不全,排除急性二尖辦反流、室间隔破裂、游离壁破裂及急性心包压塞等。1 565例患者中满足AHF临床诊断的患者有10例(Ⅰ组),其余1 555例非AHF患者(Ⅱ组),比较两组一般临床资料、PCI术过程。AHF治疗包括面罩吸氧、和(若需要)辅助人工机械通气、使用硝酸盐或硝普钠、利尿剂、正性肌力药、吗啡、主动脉内球囊反搏等。结果AHF的发病率为0．64％,10例AHF患者经过积极治疗有8例缓解并最终痊愈出院,2例AHF反复发作后死亡。与Ⅱ组患者相比,AHF患者年龄偏大、女性较多、冠状动脉病变较重、急性冠脉综合症比例较高、PCI术过程较长、造影剂剂量较多、术后容量超负荷。结论对具有上述相关危险因素的PCI患者应重视心脏功能变化,及时处理以改善症状和生存率,防止不良后果发生。
Objective To understand the incidence of acute left heart failure (AHF) within 24 hours after PCI and to analyze the clinical features and related risk factors. Methods The clinical data of 1 565 patients undergoing PCI from January 1997 to December 2006 in our department were retrospectively analyzed. According to the characteristic symptoms and signs of AHF such as cough, cough, cough and pink foamy sputum, shortness of breath, palpitations, pulse fineness Rapid, sweating, pale, skin wet and cold, peripheral cyanosis, tachycardia, Benma law, lung wet and dry 哕 sound lung (bubble) interstitial edema, hypotension or blood pressure was significantly higher, delirium and oliguria Wait. Bedside echocardiography as soon as possible to assess ventricular function and membrane dysfunction, ruled out acute mitral reflux, ruptured ventricular septal, free wall rupture and acute tamponade and so on. A total of 1 565 patients with clinical diagnosis of AHF had 10 cases (group Ⅰ), and the remaining 1 555 cases of non-AHF patients (group Ⅱ). The clinical data of two groups were compared and PCI was performed. AHF treatments include mask oxygenation and, if needed, assisted artificial ventilation, use of nitrates or sodium nitroprusside, diuretics, inotropes, morphine, intra-aortic balloon pump and more. Results The incidence of AHF was 0.64%. Ten patients with AHF underwent active treatment and 8 patients were relieved and finally discharged. Two AHF patients died after repeated attacks. Compared with patients in group Ⅱ, patients with AHF were older, more females, severe coronary lesions, higher proportion of acute coronary syndromes, longer duration of PCI, more contrast agents, and more postoperative overload. Conclusion PCI patients with the above-mentioned risk factors should pay attention to cardiac function changes, timely treatment to improve the symptoms and survival rate, to prevent the occurrence of adverse consequences.