急诊经皮冠状动脉介入治疗急性心肌梗死62例临床分析

目的：观察急诊经皮冠状动脉介入术（PCI）治疗急性心肌梗死（AMI）的临床疗效。方法：分析我院2006-09-2009-03 62例急性AMI患者36 h内行急诊PCI的临床资料。结果：60例急诊PCI成功。手术成功率96.7%,临床成功率96.7%。发病6 h内行急诊PCI的患者中远期效果明显优于发病6 h后行急诊PCI的患者（χ2=11.970,P〈0.01）。结论：急性心肌梗死（AMI）急诊行PCI术手术成功率、临床成功率高,死亡率、并发症少;有效缩短手术前时间中远期疗效明显提高。     

急性心肌梗死急诊经皮冠状动脉介入治疗近期疗效观察

目的　探讨直接经皮冠状动脉 (冠脉 )介入治疗 (PCI)对急性心肌梗死 (AMI)的疗效。方法　 6 3例AMI患者在发病 12h内接受梗死相关血管急诊PCI ,随访 1～ 14个月。结果　 6 3例患者中6 1例 (96 .8% )介入治疗获得成功。 3例行经皮冠脉腔内成形术 (PTCA) ,5 8例置入支架。全部获得TIMI 3级血流灌注。 5例发生无血流现象 ,行冠脉内尿激酶溶栓血流改善。 5例在术中发生室速、室颤 ,4例及时除颤转复窦性心律 ,1例死亡。 5例心原性休克患者有 2例住院期死亡。随访期主要事件发生率 17% (5 / 6 0 ) ,其中 2例猝死 ,1例再梗死 ,再次接受PCI成功 ,1例接受择期CABG。 1例因支架内再狭窄行再次PCI。结论　直接PCI治疗AMI可有效地使梗死相关冠脉再通 ,成功率高 ,住院病死率低 ,近期预后良好     

急性心肌梗死经皮冠状动脉治疗的护理配合

目的：探讨急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）术的临床疗效及护理措施。方法：收集我院近1年来105例急诊PCI患者为对象,进行回顾性分析,总结医护操作的关键及护理要点。结果：经PCI治疗105例患者,成功率为95.5%,平均随访1年,2例出现再狭窄,其余患者情况良好,10例再发心绞痛但造影证实为非原发心肌梗死血管病变。结论：AMI患者PCI术的关键是医生的技术水平和护士与医生的默契配合,准确的术前准备、术中熟练的操作技术配合及严密监护、术后的精心护理,都是患者康复的重要保证。     

经桡动脉与经股动脉途径行经皮冠状动脉介入治疗急性心肌梗死的对比研究

目的对经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死（AMI）的临床可行性、安全性及其疗效进行对比研究。方法 2005年10月～2007年6月期间,123例发病在12h内的STEMI患者,为常规股动脉组。2007年7月～2009年6月中行急诊PCI术的患者共126例发病在12h内的STEMI患者,为选择性桡动脉组,比较两组的手术成功率、球囊扩张时间、手术手术时间、穿刺局部出血并发症。结果桡动脉组和股动脉组手术成功率无统计学差异（96.83%vs97.56%,P〉0.05）,两组手术时间和第一次球囊扩张时间均无统计学差异（P〉0.05）,桡动脉组穿刺局部出血并发症降低,有统计学差异（P〈0.05）。结论经桡动脉直接PCI在急性心肌梗死患者中有较好的安全性和有效性。     

注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中应用价值研究

目的探讨注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用价值。方法选取淮南市新华医疗集团新华医院2019年1—12月收治的接受急诊经皮冠状动脉介入治疗的60例急性心肌梗死患者为研究对象,根据治疗方式不同,将患者分入A组(n=24)和B组(n=36)。A组患者急诊经皮冠状动脉介入治疗前给予300 mg阿司匹林肠溶片+180 mg替格瑞洛片;B组在A组基础上,即刻经导管冠状动脉内注入注射用重组人尿激酶原。比较两组患者的TIMI血流分级、超声心动图指标及30 d内主要心血管事件发生率。结果治疗前,A、B两组患者TIMI血流分级0级、1级、2级、3级所占比例比较,差异无统计学意义(P>0.05)。治疗后,A组患者TIMI血流分级0级1例(4.2%)、1级3例(12.5%)、2级12例(50.0%)、3级8例(33.3%),B组患者0级0例(0)、1级1例(2.8%)、2级8例(22.2%)、3级27例(75.0%),两组TIMI血流分级0级、1级所占比例比较,差异无统计学意义(P>0.05),2级、3级所占比例比较,差异有统计学意义(P<0.05)。治疗前,A、B两组患者室间隔厚度、左室后壁厚度、左室射血分数、左室舒张末内径比较,差异均无统计学意义(P>0.05)。治疗后,B组患者室间隔厚度、左室后壁厚度、左室舒张末内径均较治疗前减小,且小于A组,差异有统计学意义(P<0.05);同时,左室射血分数较治疗前升高,且高于A组,差异有统计学意义(P<0.05)。A组和B组主要心血管事件发生率比较(25.0%比5.6%),差异有统计学意义(P<0.05)。结论注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用能够显著改善患者心肌微循环灌溉,延缓心肌受损速度,降低不良心血管事件发生风险,减少慢血流和无复流发生率。     

平均动脉压水平对急性心肌梗死患者急诊经皮冠状动脉介入治疗预后影响

目的探讨平均动脉压(MAP)水平对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后1年内预后的影响。方法选取北部战区总医院自2016年3月至2019年3月收治的接受急诊PCI的2829例AMI患者为研究对象。根据患者术前MAP水平中位数将患者分入A组(MAP<92 mmHg,n=1414)和B组(MAP≥92 mmHg,n=1415)。比较两组患者的临床基线资料、手术资料、围术期用药情况,以及终点事件随访结果。对患者进行1年随访,研究主要终点为是否发生全因死亡,次要终点为缺血事件,包括心源性死亡、卒中、再发心肌梗死。结果B组肌酐清除率、左室射血分数及合并高血压、既往卒中、非ST段抬高型心肌梗死比例均低于A组,差异有统计学意义(P<0.05)。A组右冠状动脉为罪犯血管的比例高于B组,桡动脉入路、靶血管为左前降支的比例低于B组,差异有统计学意义(P<0.05)。B组血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂、β受体阻滞剂使用比例低于A组,差异有统计学意义(P<0.05)。B组全因死亡、缺血事件、心源性死亡发生率均低于A组,差异有统计学意义(P<0.05)。AMI患者围术期MAP与1年全因死亡发生率呈U型曲线关系,具有显著非线性相关性(P<0.05);当MAP阈值定义为100 mmHg时,全因死亡发生风险最低,以100 mmHg为参考值,无论MAP升高或降低,患者1年内发生全因死亡的风险均体现为上升趋势。结论接受急诊PCI的AMI患者的MAP水平与全因死亡发生率呈非线性相关,维持MAP稳定有助于改善患者预后。     

急诊冠脉介入治疗急性心肌梗死310例分析

目的观察急性心肌梗死患者行急诊冠脉介入治疗的有效性和安全性。方法对发病在12 h内的310例急性心肌梗死患者行急诊冠状动脉造影和冠脉介入治疗。结果310例患者中共植入465枚支架,其中裸支架119枚,药物支架346枚。304例患者介入治疗获得成功,无一死亡病例,成功率达98%。结论 对急性心肌梗死患者行急诊介入治疗是安全有效的,药物支架和裸支架一样可安全应用于急性心肌梗死的治疗。     

急性心肌梗死合并糖尿病酮症酸中毒急诊介入治疗1例

<正>1临床资料1.1基本情况患者男性,79岁。因反复头晕20年,加重伴意识障碍1 d入院。既往患高血压病20年,20 d前诊断为2型糖尿病,未服药。1 d前出现头晕,症状逐渐加重,无胸闷、胸痛。入院当日急诊科就诊时突发意识丧失、尿失禁、呼之不应,急诊测血压80/40 mm Hg(1 mm Hg=0.133 k Pa),给予补液、升压治疗1 min后,意识恢复。     

MDCT coronary angiography for diagnosis of anomalous origin right coronary artery: a case report

This is a case report of anomalous origin of the right coronary artery, which arises from the left sinus of Valsalva depicted with multi-detector row tomography (MDCT) coronary angiography performed in emergency. In symptomatic patient, this anomalous origin is considered a malignant anomaly and needs urgent surgical treatment. Some studies demonstrated that MDCT is a reliable non-invasive technique to identify and define anomalous coronary arteries (ACAs) and their course.     

孕产妇伴发急性心肌梗死2例并文献回顾

目的 探讨孕产妇急性冠状动脉综合征(ACS)的病因和诊治方法.方法 报道2例孕产期妇女因突发胸痛就诊,依据心电图和心肌坏死标记物动态变化,心脏MRI和冠状动脉造影(CAG)明确诊断.结果 依据心电图和心肌酶动态变化,2例孕产妇均确诊为急性心肌梗死.其中第2例CAG显示前降支近段局限性线状透明影,提示自发性冠状动脉夹层(SCAD),心脏MRI证实前壁心肌梗死.结论 SCAD为孕产妇伴发ACS的主要原因,CAG是诊断金标准.应依据患者实际情况选择治疗方案.     

Magnetic resonance imaging demonstration of anomalous origin of the right coronary artery from the left coronary sinus associated with acute myocardial infarction

Coronary MR angiography can be useful for noninvasive diagnosis of potentially life-threatening coronary artery anomalies. However, there has been no report to date on MR demonstration of acute myocardial infarction associated with right coronary artery anomaly. A 55-year-old man was admitted with chest pain. Catheter coronary angiography revealed an anomalous origin with compression in the proximal segment of right coronary artery. Breath-hold MR angiography using spiral acquisition technique showed that the right coronary artery originated from the left coronary sinus with a separate os. The proximal segment of the artery was compressed by right ventricle outflow tract during the diastolic phase of cine MR imaging. Contrast-enhanced MR imaging 5 minutes after Gd-DTPA injection showed hyperenhancement suggestive of acute myocardial infarction in the posteroinferior wall of the left ventricle.     

Case report: Isolated right coronary artery obstruction presenting as acute anterior myocardial infarction

A patient presented with chest pain and S-T segment elevation in the anterior chest leads diagnostic of acute anterior myocardial infarction (MI). The non-invasive imaging studies showed no evidence of left ventricular anterior MI but showed a right ventricular MI. Coronary angiography showed an isolated right coronary artery obstruction. Occasionally, the ECG in acute right ventricular myocardial infarction may resemble an anterior MI. The differentiation is important from a therapeutic viewpoint.     

Shepherd's crook configuration of right coronary artery and anomalous origin of left circumflex artery from right coronary cusp in a middle-aged man—A case report

Shepherd''s crook configuration of the right coronary artery is a course anomaly where the ostium is oriented superiorly with the proximal artery taking an upward turn before resuming its regular path. Although it is classified as an unimportant hemodynamic variation, it is relevant in the context of coronary artery disease due to the technical issues it causes when being treated. The anomalous origin of the left circumflex artery arising as a separate branch from the right coronary cusp is a rare variant and its significance lies in its association with sudden arrhythmia, syncope, and sudden cardiac death. Here we report a case of a 58-year-old male patient with an anomalous course of the right coronary artery consistent with Shepherd''s crook configuration and anomalous origin of the left circumflex artery from the right coronary cusp.     

急性心肌梗死合并肾梗死1例

临床资料 患者男,45岁.因“持续性胸闷,胸痛2d”于2015年5月17日入院,否认高血压、糖尿病、心脏病病史,有吸烟史30年,约20支/d,少量饮酒,曾有吸毒史.患者于3d前晚19时许无明显诱因突发胸骨下段压榨性疼痛,无放射痛,伴大汗淋漓、恶心、呕吐胃内容物、咳嗽咯痰,持续无缓解,遂来娄底市中心医院心血管内科就诊.     

单左冠状动脉畸形2例

例1 男,69岁.间断胸痛1月,以夜间为著,体检运动平板试验( ),冠脉CT未见右冠显影(图1),左冠回旋支发出侧支走行于右冠供血区.左冠前降支及回旋支同时发源于左窦.左冠前降支近中段可见多发混合性斑块伴团块状钙化影,管壁不规则增厚,相应层面管腔中重度狭窄,狭窄程度50%～图1 未见右冠显影,左冠回旋支发出侧支走行于右冠供血区图2 右冠缺如,左冠回旋支发出侧支供应右室供血区域70%,远段血流尚通畅.     

Prostate brachytherapy seed migration to the right coronary artery associated with an acute myocardial infarction

PURPOSE: We report a case of prostate brachytherapy seed migration to the right coronary artery (RCA) associated with an acute myocardial infarction (AMI). METHODS AND MATERIALS: A 69-year-old male was diagnosed with Prostate Adenocarcinoma Stage II (T(1c)N0M0) in October 2003. He underwent percutaneous transperineal interstitial permanent prostate brachytherapy with the implantation of 94 loose iodine (125I) seeds under transrectal ultrasound guidance on 15 December, 2003. The implantation was designed to deliver a minimum dose of 144 Gy. RESULTS: Postimplant pelvic radiography at Day 30 showed five seeds missing. No chest radiography was done until hospital admission on October 10, 2005 for AMI. Cine radiography from cardiac catheterization revealed 86 metallic seeds remaining in the pelvic region, 4 that had migrated to the lungs (2 left and 2 right) and 2 to the heart. Two seeds were unaccounted for. Of the two cardiac seeds, one was lodged in the right ventricle endocardium and the other in the midsegment of the RCA at the site of a severely stenotic lesion that resulted in an AMI. CONCLUSIONS: To our knowledge, this is the first case of brachytherapy seed migration to the RCA associated with an AMI. Echocardiography before brachytherapy seed implantation might be considered in patients felt to be at high risk for cardiac shunting.     

Duplicate origin of the vertebral artery: report of two cases

Summary We report two cases showing duplicate origin of the vertebral artery; one with fenestaration of the distal portion of the left vertebral artery.