急性心肌梗死急诊经皮冠状动脉介入术护理

急性心肌梗死（AMI）是冠心病死亡的主要原因，在我国有患者人数明显增加且年轻化的趋势，对伴有ST段抬高的AMI，尽早、充分、持续地开通梗死相关血管（IRA）是改善患者预后是关键所在。急诊经皮冠状动脉介入术（PCI）．是应用机械的方法直接开通闭塞的冠状动脉（冠脉），是一项恢复冠脉血流最直接、最有效的再灌注疗方法之一。自我科开展急诊PCI以来，我们对手术患者进行了详细、及时的术前宣教，准备及加强术后的监测、健康指导等护理策略，使患者能顺利手术治疗和满意出院。现初步总结如下：     

年龄对接受急诊经皮冠状动脉介入术治疗急性ST段抬高型心肌梗死患者预后的影响

目的:分析年龄对接受急诊经皮冠状动脉介入术(PCI)治疗的急性ST段抬高型心肌梗死患者预后的影响。方法:选取接受急诊PCI治疗的148例急性ST段抬高型心肌梗死患者作为研究对象,根据患者的年龄将其分为I组53例(<65岁)、II组51例(65～74岁),III组44例(≥75岁)。术后随访36个月,统计三组患者主要心脏不良事件(MACE)发生率。结果:I组发生MACE 2例(3.77%),II组发生MACE 5例(9.80%),III组发生MACE 11例(25.00%),三组MACE发生率比较,差异有统计学意义(P<0.05)。结论:接受急诊PCI治疗的急性ST段抬高型心肌梗死患者的MACE发生率随着年龄的增大而升高,应引起临床高度重视。     

急性 ST 段抬高型心肌梗死直接冠状动脉介入术中护理

目的：探讨急性 ST 段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术中护理配合的重要性。方法回顾性分析70例急性 STEMI 患者急诊入导管室直接 PCI 治疗的病例资料、救治过程、护理措施,分析护理配合对提升 PCI 成功率的意义。结果手术成功69例,成功率为98.57%;1例急性广泛前壁心肌梗合并心衰的高龄患者抢救无效死亡,死亡率为1.43%。结论准确判断、迅速实施介入治疗是手术成功的关键;密切观察、术中配合默契是手术成功的保障。高质量的护理配合对提升 PCI 成功率起到很大支持作用。     

经桡动脉与股动脉行经皮冠状动脉介入术治疗急性ST段抬高型心肌梗死的效果比较

目的:比较经桡动脉与股动脉入路行经皮冠状动脉介入术(PCI)治疗急性ST段抬高型心肌梗死(STEMI)的临床效果。方法:选取该院收治的101例急性STEMI患者为研究对象,采用随机数字表法将其分为对照组(n=50)和观察组(n=51)。对照组采取经股动脉入路行PCI治疗,观察组采取经桡动脉入路行PCI治疗,比较两组置管时间、手术时间、术后卧床时间、PCI成功率及并发症发生率。结果:观察组置管时间长于对照组,术后卧床时间短于对照组,差异均有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);两组PCI成功率比较,差异无统计学意义(P>0.05);观察组并发症发生率为5.88%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论:经桡动脉入路行PCI治疗急性STEMI,PCI成功率与经股动脉入路相当,但能够缩短术后卧床时间,减少并发症。     

心肌梗死经皮冠状动脉介入术的护理进展

心肌梗死(AMI)是心肌缺血性坏死,是在冠状动脉病变的基础上,发生冠状动脉血供急剧减少或中断,使相应的心肌严重而持久地急性缺血所致[1].     

急性ST段抬高心肌梗死患者血管开通时间延迟的影响因素分析

目的探讨ST段抬高心肌梗死(STEMI)患者血管开通时间延迟的影响因素。 方法选取本院204例STEMI行急诊经皮冠状动脉介入治疗手术患者,根据患者延迟时间、系统延迟时间、院内延迟时间分别进行分组。采用单因素及Logisitic回归分析各组血管开通时间延迟的影响因素。 结果患者延迟时间≤90 min组93例,＞90 min组111例;女性、高龄、自费、居住地在城郊或农村、到院距离＞10 km、发病时间在非正常工作时间是患者延迟时间的危险因素,文化程度高、入院方式为紧急救援系统(EMS)、发病时有陪护者是患者延迟时间的保护因素。系统延迟时间≤120 min组119例,＞90 min组85例;乡镇转院、EMS入院、非正常工作时间是系统延迟时间的危险因素。院内延迟时间≤90 min组173例,＞90 min组31例;乡镇转院、EMS入院是院内延迟时间的保护因素,非正常工作时间是院内延迟时间的危险因素。 结论非正常工作时间是STEMI患者血管开通时间延迟的危险因素。     

慢性冠状动脉闭塞病变与急性ST段抬高心肌梗死经皮冠状动脉介入治疗的对照研究

目的比较慢性冠状动脉闭塞病变（CTO）与急性ST段抬高心肌梗死（ASTEMI）经皮冠状动脉介入治疗（PCI）前后疗效。方法59例冠心病患者,根据WHO标准分成慢性冠状动脉闭塞病变组30例和急性ST段抬高心肌梗死组29例。行冠状动脉支架置入,术后对梗死相关动脉TIMI血流、心电图、心功能、心肌损伤标志物等资料进行统计对比分析。结果PCI对慢性冠状动脉闭塞病变梗死相关动脉TIMI血流提高到3级可达93.33%,但对心电图ST-T改变、心肌损伤标志物的峰值和达峰时间、心功能（EF值）、左室收缩末期内径（LVESD）和舒张末期内径（LVEDD）以及短轴缩短率（FS）均无影响（P〉0.05）。而PCI对ASTEMI手术前后的梗死相关动脉TIMI血流3级、心电图ST-T回落、心肌损伤标志物术后峰值、心功能均有统计学意义（P〈0.05）。结论PCI对急性ST段抬高心肌梗死的临床益处已被公认,但对慢性冠状动脉闭塞病变的临床效果有待进一步观察。     

急性ST段抬高型心肌梗死行急诊经皮冠状动脉介入前心电图预判冠脉闭塞部位的临床价值

目的 探讨急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)术前心电图预判冠脉闭塞部位的临床价值.方法 全面分析311例STEMI患者18导联心电图改变,预判出冠状动脉闭塞的部位,与冠状动脉造影结果进行对比分析.结果 急性广泛性前壁心梗心电图预判的敏感性、特异性分别为88.1%、81.2%(47/58),前间壁为90.2%、79.6%(78/98),前侧壁为69.3%、57.7%(30/52).急性下壁心肌梗死心电图预判的敏感性、特异性分别如下:右冠状动脉近端96.1%、90.4%(47/52);远端83.3%、92.7%(51/55);左冠状动脉回旋支为50.0%、97.0%(96/98).结论 通过18导联心电图,绝大部分病例能在术前较精确地预判冠状动脉的急性闭塞部位,有利于急诊PCI的顺利进行,对于指导STEMI的治疗、手术风险的评估、预测患者的预后等均有重要的临床意义.     

血糖对非ST段抬高心肌梗死经皮冠状动脉介入术后心功能的影响

目的观察血糖对非ST段抬高心肌梗死经皮冠状动脉介入治疗（PCI）后心功能的影响。方法选取非ST段抬高心肌梗死PCI患者144例,根据血糖分为三组,A组〈7．8mmol／L,68例,B组7。8～11．1mmol／L,43例,C组〉11．1mmol／L,33例。术后1周内行超声心动测定左心室射血分数（LVEF）。结果B、C组患者年龄较大E（62．6±10．3）岁比（57．2±11.2）岁,P〈0．053。冠脉造影结果B、c组多支血管病变较多（67．4％、66．7％比50．O％,P〈0．05）。PCI术后TIMI血流分级3级,三组差异无统计学意义（P〉0．05）。左心室射血分数B、C组明显降低[（51．4±7．0）、（49．6±7．1）比（58．5±7．2）,P〈0．05]。30d内心脏不良事件发生率B、C组与A组比较差异虽无统计学意义,但有增加趋势。病死率C组明显多于A组（9．1％比1.5％,P〈0．05）。结论血糖升高的急性非ST段抬离心肌梗死PCI患者较血糖正常者心功能差,心脏不良事件发生率高,病死率增加。     

重组人尿激酶原治疗急性ST段抬高型心肌梗死的临床研究

目的：评估急性ST段抬高型心肌梗死(STEMI)病人行急诊经皮冠状动脉介入治疗(PCI)术中给予冠状动脉内注射重组人尿激酶原溶栓的有效性和安全性。方法：126例中观察组61例,冠状动脉造影发现罪犯血管后给予重组人尿激酶原20 mg, 10 min后再次造影,观察冠状动脉血流,评估冠状动脉血管病变情况后选择合适的支架植入;对照组65例,冠状动脉造影发现罪犯血管后根据冠状动脉血管病变情况直接选择合适支架植入。比较2组病人术后ST段回落率、肌钙蛋白I峰值和肌酸激酶同工酶水平、心功能指标、住院期间出血事件和主要不良心血管事件(MACEs)及术后随访1、6个月MACEs发生情况。结果：观察组血清肌酸激酶同工酶和肌钙蛋白I峰值水平均低于对照组(P<0.05),ST段完全回落(≥70%)多于对照组(P<0.05)。2组病人PCI术后1 d左心室射血分数(LVEF)和舒张末期内径(LVEDd)差异均无统计学意义(P>0.05),观察组N端脑钠肽前体水平低于对照组(P<0.05);术后1个月,观察组LVEF和LVEDd均优于对照组(P<0.05)。2组病人住院期间出血事件和...     

Long-term outcome of native artery versus bypass graft intervention in prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction

Background Patients with prior coronary artery bypass graft (CABG) have a poor outcome after acute myocardial infarction (AMI).Little is known about the treatment strategy and outcome of percutaneous c...     

Comparison of tirofiban combined with dalteparin or unfractionated heparin in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction patients

Background  Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.

Methods  From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2±9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5±10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.

Results  There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.

Conclusions  Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.

     

急性ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗联合血栓抽吸术的疗效观察

目的 评价急性ST段抬高型心肌梗死患者行急诊介入治疗联合血栓抽吸对患者的预后疗效.方法 回顾性分析2014年1月至2015年1月共313例急性ST段抬高型心肌梗死行急诊介入治疗患者的临床资料,分为联合血栓抽吸组(n=97)和直接PCI组(n=216).应用SPSS统计软件进行t检验、非参数检验,对两组患者在基本资料(年龄、性别)、冠脉危险因素(吸烟、糖尿病、高血压)、入院时基本临床资料[血钾、血糖(GLU)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、血肌酐(Cr)、缺血时间和KILLIP分级]、造影结果(罪犯血管、非罪犯血管数、后扩张数、TIMI分级、)、术后LVEF以及MACE(主要不良心血管事件)进行比较.结果 两组患者在基本资料、冠脉危险因素、入院时基本临床资料、冠脉造影结果以及术后LVEF方面,差异均无显著性意义(P＞0.05),而在Cr及罪犯血管方面差异有显著性意义(P＜0.05).平均随访12个月,MACE率联合抽吸组25.8％,直接PCI组16.2％,两组比较,差异有显著性意义(P =0.047).结论 急性ST段抬高型心肌梗死患者行急诊介入治疗中,联合血栓抽吸治疗并不能够降低远期MACE事件.     

直接经皮冠状动脉介入治疗应用血栓抽吸对STEMI患者心肌灌注及临床预后的影响

目的 探讨直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)应用血栓抽吸对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者心肌灌注及临床预后的影响.方法 采用回顾性研究方法...     

急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后非梗死相关动脉病变进展的临床研究

目的观察急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后梗死相关动脉病变进展情况及其临床相关因素。方法对519例STEMI患者直接PCI治疗,临床随访6个月,观察患者因冠心病临床症状再次血管重建率。结果 112例患者因冠心病临床症状行冠状动脉造影检查,其中72例患者行再次PCI治疗,其中罪犯血管PCI 27例(梗死相关动脉再次PCI组:包括支架内再狭窄19例,支架血栓8例),非梗死相关动脉病变进展45例(非梗死相关动脉再次PCI组);未再次PCI患者447例(未再次PCI组)。3组患者年龄、性别、糖尿病、高血压、高脂血症、吸烟、既往心肌梗死、既往PCI、既往冠状动脉旁路移植术、左心室射血分数、血清低密度脂蛋白-胆固醇水平、≥2支血管病变率比较差别均无统计学意义(P>0.05),而血清C-反应蛋白水平、直接PCI支架长度比较差别有统计学意义(P<0.001)。结论急性STEMI患者直接PCI术后再次血管重建主要是由于非梗死相关动脉病变进展所致。     

急性心肌梗死患者急诊介入术中血栓抽吸的临床应用评价

目的:对急性心肌梗死(AMI)患者行直接经皮冠状动脉介入治疗中应用血栓抽吸术的疗效进行评价,探讨血栓抽吸术在急性心梗患者直接经皮冠状动脉介入治疗(PCI)中的应用价值。方法:收集吉林大学中日联谊医院心内科2007年3月～2010年3月收住的急性心肌梗死患者中急诊冠脉造影提示梗死相关动脉血流TIMI 0～1级、并行PCI治疗的36例患者的临床资料。对比分析应用抽吸技术的患者及对照组的临床及造影资料。结果:对于行血栓抽吸的直接PCI患者,其心肌灌注水平高于常规PCI治疗组,但其心功能相关指标未见明显差异。结论:直接PCI是急性心肌梗死心肌再灌注的重要方法,通过血栓抽吸可改善心肌再灌注水平。     

Double coronary artery thrombosis presenting as acute extensive anterior ST-segment elevation myocardial infarction

Simultaneous thrombosis of more than one coronary artery is an uncommon angiographic finding in acute ST-segment elevation myocardial infarction (STEMI), and usually leads to cardiogenic shock or even sudden cardiac death. We reported a 56-year-old man presenting with persistent chest tightness and ST-segment elevation over precordial leads in electrocardiography (ECG). Emergent coronary angiogram showed total occlusion of both the proximal right coronary artery (RCA) and the proximal left anterior descending artery (LAD). We performed thrombus aspiration and stenting over the LAD with thrombolysis in myocardial infarction (TIMI) III flow to the distal LAD. However, diminishing collateral flow to the distal RCA complicated with complete atrioventricular block (CAVB) and cardiogenic shock developed thereafter. Because distal embolization of the collateral circulation from the LAD to the distal RCA was suspected, thrombus aspiration and stenting over the proximal RCA were performed. After reperfusion of the RCA, the patient's hemodynamic status stabilized and he recovered uneventfully.     

Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

Background  Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events.

Methods  A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke.

Results  Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P <0.05) and a faster heart rate (P <0.05), and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤7 on admission (P <0.001). And the in-hospital mortality was higher in the OHCA patients (55.6% vs. 2.4%, P <0.001). Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS ≤7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization (P <0.001, P <0.05). And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs. 84.3%, P <0.001).

Conclusions  During hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

     

Primary percutaneous coronary intervention on older patients with acute ST-segment elevation myocardial infarction: analysis of its risk factors

Objective： The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction （STEMI） following primary percutaneous coronary intervention （PCI）. Methods： A total of 136 patients older than 60 years with STEMI who received successful PCI were included in this study. The patients were classified in 2 age groups： patients 〉75 years and 〈75 years of age. The extent of coronary artery lesions was measured by quantitative coronary artery angiography （QCA）. Subjects were tracked for subsequent cardiovascular events： cardiac death, myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery bypass and stroke. Results： Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than patients〈75y （P〈0.05）, the procedural success did not make difference between the two groups. In 12 months follow-up of 136 study participants, there occurred 39 CV events ： cardiac death （five patients）, heart failure （nineteen patients）, and stroke （six patients）. Three patients received coronary bypass grafts and six patients underwent PCI. Heart failure and overall cardiovascular event rates were higher in older patients compared with those in patients〈75y. The main adverse clinical events （MACE） for the old group were a little higher comparing with the younger in 12-month follow-up （P=-0.029 6 and P=-0.043 4）. Multivariate cox analysis identified that a diagnosis of diabetes （HR 2.495, 95%CI 1.224 to 5.083, P= 0.011 8） and time from symptom（HR 1.450, 95%CI 1.143 to 1.841, P= 0.008 2） to PCI as independent predictors of CV events after adjustment of all entered baseline variables. Conclusion： Our study suggests that drug-eluting stent implantation in older patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time from symptom onset to PCI may decrease cardiovascular events in old patients following PCI.     

左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

目的 探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法 对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction, LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events, MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果 两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论 在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。