急诊冠脉介入治疗急性心肌梗塞的临床观察

目的：观察急诊冠脉介入治疗急性心肌梗塞（AMI）的安全性及有效性。方法：对42例AMI患者在发病0．5～12小时内行直接PTCA术，必要时联合临时心脏起搏技术及主动脉气囊反搏术，梗死相关血管（IRA）43支，TIMI血流0级：30例（71．4％），Ⅰ级：9例（21．4％），Ⅱ级：3例（7．2％）。结果：43支IRA中39支获得再通（90．9％），均达TIMI Ⅲ级血流，再通血管残余狭窄〈20％，5例合并左心功能不全（killip分级Ⅱ～Ⅲ级）及3例合并心源性休克患者，术后症状明显改善，1例死亡（2．5％）。术后6例（15％）直接PTCA成功患者心绞痛再发，再次PTCA后血管再通。结论：直接PTCA治疗AMI成功率高，病死率低，近期预后良好，是一种安全有效的治疗方法。     

急性心肌梗塞急诊PTCA后ST段改变及其临床意义

目的　对９５ 例急性心肌梗塞（ＡＭＩ）患者急诊经皮冠状动脉腔内成形术（ＰＴＣＡ）后３０ 分钟体表心电图ＳＴ 段改变进行分析,探讨此时ＳＴ 段改变与ＰＴＣＡ 效果、心肌损害程度及心功能预后的关系。方法　根据ＳＴ 段改变分三组。组Ⅰ：ＳＴ 段明显下降（≥５０％ ）组５５ 例,组Ⅱ：ＳＴ 段下降（＜ ５０％ ）组３２ 例,组Ⅲ：ＳＴ 段无变化或抬高者组８ 例。测定术后肌酸激酶（ＣＫ）的变化,同时测定术前及术后心功能。结果　组Ⅰ与组Ⅱ为ＰＴＣＡ 成功者,术后组ⅡＣＫ 明显高于组Ⅰ。术后４～６ 周组Ⅱ射血分数（ＥＦ％ ）明显低于组Ⅰ。结论　急性心肌梗塞患者ＰＴＣＡ 术后３０ 分钟体表心电图ＳＴ 段的改变能间接反映ＰＴ－ＣＡ 疗效。较准确早期了解心肌细胞灌注情况并判定预后     

急诊PTCA与溶栓治疗急性心肌梗死近期疗效对比研究

目的:对急诊PTCA和溶栓在急性心肌梗死(AMI)治疗中的近期疗效作一对比研究。方法:回顾性分析中山医院自2001年1月至2001年11月收治的行急诊PTCA和溶栓治疗的85例AMI患者的资料.并分析其临床不良事件的发生率、超声心动图检查结果。结果:急诊PTCA患者49名,溶栓患者36名。溶栓组的室性心律失常发生率(25%)、梗死后心绞痛(22.22%)、心源性休克(25%)、左室室壁运动积分指数(1.82±0.32)、行冠状动脉旁路手术(CABG)者(13.89%).死亡率(27.78%).平均住院天数(25.06±16.37)d.分别高于PTCA组的2.04% (P<0.01)、6.12%(P<0.05)、6.12%(P<0.05)、1.47±0.34(P<0.01)、0(P相似文献   

青年人及老年人急性心肌梗死直接经皮冠状动脉腔内成形术的特征

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Arterial blood infusion for myocardial protection during percutaneous transluminal coronary angioplasty

Much of the potential risk of percutaneous transluminal coronaryangioplasty relates to regional myocardial ischaemia duringballoon inflation. We have investigated the protective effectof infusing arterial blood through the angioplasty catheterinto the distal coronary artery during 60 second balloon inflations.Symptomatic, electrocardiographic and echocardiographic indicesof regional ischaemia were monitored during inflations withand without blood infusion. The effect of infusing Hartmann'ssolution was also evaluated to control for washout effects.Twelve patients were studied. Inflation without blood producedchest pain in eight patients, ST-segment elevation in ten patientsand regional wall motion abnormalities in every case. Duringblood infusion manifestations of ischaemia were either delayedor prevented altogether. Chest pain occurred in only one patientwhile ST segment elevation and regional wall motion abnormalitiesoccurred in three and four patients, respectively. Infusionof Hartmann's solution, on the other hand, had no significanteffect on the development of regional myocardial ischaemia duringballoon inflation indicating that delivery of arterial oxygenand not washout of metabolites was responsible for the beneficialeffects of blood infusion. These data indicate that distal coronaryperfusion with arterial blood during angioplasty reduces regionalmyocardial ischaemia and has the potential to improve the safetyof the technique and to permit more prolonged periods of ballooninflation.     

Physiological aspects of percutaneous transluminal coronary angioplasty

Summary Percutaneous transluminal coronary angioplasty (PTCA) can serve as a model for controlled coronary artery occlusion and reperfusion, which enable the dynamic physiological alterations related to PTCA to be assessed. In this review, physiologically related changes pertinent to PTCA in human subjects will be discussed.     

急性心肌梗死经皮冠状动脉成形术治疗的近期疗效

目的：观察急性心肌梗死（AMI）经皮冠状动脉成形术（PTCA）及原发性冠状动脉内支架植入术的近期疗效。方法：204例AMI患发病0．5－26h内行急诊冠状动脉造影（CAG）,证实冠状动脉闭塞,仅对梗死相关血管直径行TPCA及原发性冠状动脉内支架植入,。结果：全组204例患再通197例,成功率96％,发病至血管再通的时间1－27h,平均5．6h,PTCA失败7例,其中心包填塞2例,钢丝不能通过2 ,术中死亡2例（均发生在伴有心源性休克的前壁心肌梗死患）,率为0．9％,5周内死亡2例（经PTCA及支架植入术后心功能未明显改善,死亡心功能不全）,2－6个月死亡6例（因再发心肌梗死而死亡,总死亡率4．9％。结论：AMI后早期（6h内）成功的再灌注可挽求涉死的心肌,缩小梗死面积和明显降低死亡率,即使 在较晚时间（＞12h),病人仍有胸痛及ST段抬高,使梗死的血管再通仍可达到治疗的目的。早期充分的再灌注可明显改善患的预后,急诊TPCA治疗,可命名开通闭塞血管的届时时间提前,PTCA后残余狭窄甚微,再灌注血流充分,极少发生恢复期心肌缺务及心功能不全,在条件的大型A,TPTCA治疗AMI的最佳方法。     

补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞

目的探讨补救性经皮冠状动脉腔内成形术（ＰＴＣＡ）在治疗急性心肌梗塞（ＡＭＩ）中的作用。方法对溶栓治疗失败的３６例患者进行补救性ＰＴＣＡ治疗。患者心功能Ｋｉｌｐ分级：Ⅲ级和Ⅳ级４例，Ⅱ级和Ⅰ级３２例。冠状动脉造影显示梗塞相关动脉：前降支１７例，右冠状动脉１４例，回旋支４例，中间动脉１例。ＰＴＣＡ前ＴＩＭＩⅠ级和Ⅰ～Ⅱ级血流各２例，余３２例均为ＴＩＭＩ０级。３６例均进行ＰＴＣＡ治疗，其中１３例患者置入了支架。结果术中除３例失败外，３１例患者病变血管血流达到ＴＩＭＩⅢ级，２例ＴＩＭＩⅡⅢ级，残余狭窄≤５０％，成功率为９１．７％。院内并发症：１例在ＰＴＣＡ成功后当天因顽固性休克和心室纤颤死亡；１例于第３天死于心脏破裂，住院病死率为５．６％。１４例患者在术后１～２个月内复查冠状动脉造影，２例发生再狭窄。结论ＡＭＩ患者在溶栓治疗失败后，在有条件的医院可施行补救性ＰＴＣＡ治疗，成功率高，对改善患者的近期和远期预后可能有利     

冠状动脉旋磨术及经皮冠状动脉成形术在复杂病变介入治疗中的应用

目的　探讨冠状动脉旋磨术 (Rotational atherectomy)及经皮腔内冠状动脉成形术 (Percutaneous translum i-nal coronary angioplasty PTCA)治疗复杂冠脉病变的临床效果。方法　对 15例患者的 2 0处病变行冠脉旋磨术及经皮腔内冠状动脉成形术 (PTCA)治疗 ,部分病例并在血管内超声指导下进行 ,观察其治疗的即刻成功率及并发症率。结果　 15例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,平均狭窄程度由 88.30 %± 7.5 4 %降至15 .6 0 %± 10 .75 %。其中 6 0 .0 0 %的病例选择了 1.5 mm的旋磨头 ,13.33%的病例使用了 2个旋磨头。全部病例均联合应用了 PTCA,13例在行旋磨术后置入冠脉内支架 (余下 2例为支架内再狭窄病例 )。 1例患者术中发生较严重的冠状动脉痉挛 ,经冠状动脉内给予硝酸甘油后缓解 ;2处 (10 .0 0 % )病变出现了 B型以上的内膜撕裂 ,出现缓慢血流现象发生率为 3.8%。无急诊冠状动脉搭桥及死亡病例。结论　冠状动脉旋磨术及 PTCA可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 ,小血管长节段病变     

急性心肌梗塞直接经皮冠状动脉腔内成形术

目的观察急性心肌梗塞（ＡＭＩ）患者应用直接经皮冠状动脉腔内成形术（ＰＴＣＡ）的安全性和有效性。方法对１１４例ＡＭＩ患者在发病１２小时内行直接ＰＴＣＡ术,其中有５例心原性休克的患者。梗塞相关血管（共１１５支血管）：左主干３例（２．６％）,前降支５６例（４８．７％）,回旋支１２例（１０４％）,右冠状动脉４４例（３８．５％）。ＴＩＭＩ血流：０级８２例（７１．３％）,１级１７例（１４．７％）,２级１６例（１４．０％）。结果１１１例患者手术成功,ＴＩＭＩ血流３级（９７．４％）。住院期间死亡３例（２．６％）,均为心原性休克患者,其中２例经紧急冠状动脉旁路移植术后死亡。８５例患者置入了冠状动脉内支架（７３．９％）。随访９５例患者,２例后期死于心力衰竭,９例出院后出现心肌缺血,其中８例再次行ＰＴＣＡ术。结论直接ＰＴＣＡ是治疗急性心肌梗塞的安全有效措施,成功率较高,并发症少;术后复发心肌缺血发生率较溶栓治疗低。     

缺血预适应在经皮冠状动脉腔内成形术中的应用

对２６例冠心病患者随机分为预适应组（１４例）和对照组（１２例），分别观察经皮冠状动脉腔内成形术（ＰＴＣＡ）中心绞痛及心电图变化和术后心绞痛及运动心电图。结果显示：预适应组术中心绞痛积分和ＳＴ段抬高幅度均显著低于对照组（均Ｐ＜０．０５），心绞痛及ＳＴ段抬高出现时间均显著迟于对照组（均Ｐ＜０．０５）。术后随访６个月，预适应组心绞痛及运动心电图阳性例数显著低于对照组（均Ｐ＜０．０５）。表明缺血预适应不但可以减轻ＰＴＣＡ中心肌缺血的程度，而且也能降低术后心肌缺血的复发。     

Recurrence of coronary artery spasm after successful percutaneous transluminal coronary angioplasty

A 47-year-old man presented with angina, and coronary angiograms showed a significant organic stenosis with spasm in the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was successfully performed for the organic lesion in the left anterior descending coronary artery. Symptom of angina due to coronary artery spasm recurred, even without restenosis at the site of successful angioplasty.     

溶栓及PTCA治疗急性心肌梗塞92例临床分析

本文总结１９９１年８月至１９９６年４月应用溶栓及ＰＴＣＡ治疗ＡＭＩ９２例，男７６例，女１６例，年龄４６～７０岁之间，平均年龄６０．２±１０．５岁。治疗分为：①冠状动脉内输注尿激酶（ＩＣＵＫ）组３２例；②静脉输注尿激酶（ＩＶＵＫ）组４１例；③经皮冠状动脉腔内成形（ＰＴＣＡ）组１９例。全组再通６９例，总再通率为７５．０％，ＩＣＵＫ组、ＩＶＵＫ组、ＰＴＣＡ组再通率分别为７５．０％、６５．７％和９４．７％三组再通率比较有显著差异。三组患者近期预后比较：全组９２例，死亡９例，死亡率９．７８％，８例发生于梗塞血管未通者，１例发生于血管再通者。ＩＣＵＫ组３２例，死亡３例（９．３７％），发生心功能不全８例（２５．０％）；ＩＶＵＫ组４１例，死亡５例（１２．０％），发生心功能不全１１例（２６．８３％）；ＰＴＣＡ组１９例，死亡１例，死亡率为５．２６％，ＰＴＣＡ组无心功能不全者。     

Experience of percutaneous transluminal coronary angioplasty in orthotopic cardiac transplant recipients

We evaluated the role of percutaneous transluminal coronaryangioplasty (PTCA) in a series of orthotopic cardiac transplantrecipients with severe epicardial coronary occlusive disease.Ten ortho topic cardiac transplant patients treated by PTCAup to March 1990 were reviewed. All had significant epicardialcoronary artery lesions (>70% stenosis compared with theadjacent healthy artery) and exercise electrocardiogram or isotopeperfusion evidence of myocardial ischaemia in the relevant region.Primary angiographic PTCA success was achieved in 12 of the16 lesions attempted (75%). Mean stenosis improvement was from80% of adjacent healthy artery (range 70–90%) to 12% (range0–20%). Median angiographic follow-up of 9 months (2–25months) is available for all patients. The mean recurrence rateis 33% (4 of 12 successfully treated lesions) defined as >50%reduction in the original gain at the PTCA. We have shown thatPTCA is technically possible in a series of cardiac transplantrecipients. The primary success and recurrence rates are comparableto the use of PTCA in conventional atherosclerotic coronarydisease.     

直接经皮腔内冠状动脉成形术对急性心肌梗死QT离散度的影响

目的 :研究急性心肌梗死 (AMI)后直接经皮腔内冠状动脉成形术 (PTCA)对 QT离散度 (QTd)的影响。方法 :回顾 95例 AMI患者 ,通过测量入院时及入院后不同时间心电图。对比分析其中 6 8例 PTCA再通患者 (PTCA组 )与 2 7例未行 PTCA或溶栓患者 (对照组 )不同时间 QTd的变化。结果 :PTCA组再通即刻 QTd、Q Tcd较再通前明显延长 (P <0 .0 1) ,2 h后恢复到入院时水平 ,4h后较入院时明显缩短 (P <0 .0 1) ,以后 2 4h内相对稳定。对照组入院后 2 4h内 QTd、QTcd变化不大 (P >0 .0 5 )。结论 :AMI后成功的 PTCA治疗可以缩短心室复极的 QTd,但再灌注即刻可延长 QTd     

心绞痛患者QT离散度与经皮腔内冠状动脉成形术的关系

目的 :探讨经皮腔内冠状动脉成形术 ( PTCA)对心绞痛患者 QT及 JT离散度 ( QTd及 JTd)的作用。方法 :测定 5 0例心绞痛患者 (心绞痛组 ) PTCA术前和术后的 QTd及 JTd,并以 5 0例正常冠状动脉者作对照 (对照组 )。结果 :1心绞痛组于 PTCA后 QTd及 JTd显著减小 ( P <0 .0 1) ,而对照组于冠状动脉造影术后 QTd及JTd与术前比较 ,无明显改变。 2与对照组比较 ,心绞痛组 PTCA前 QTd及 JTd明显增大 ( P <0 .0 1)。术后心绞痛组 QTd及 JTd值虽高于对照组 ,但无统计学意义 ( P >0 .0 5 )。结论 :PTCA能使 QTd及 JTd减小     

Coronary artery vasomotion after percutaneous transluminal coronary angioplasty

Substantial evidence of postangioplasty vasoconstriction is available, both at the dilated site and distal to balloon injury, demonstrating its frequent occurrence. It is likely that even mild or moderate vasoconstriction at the site of balloon injury may create flow turbulence, promoting platelet aggregation and contributing to thrombotic vessel closure. The regulation of arterial smooth muscle tone is a complex process and should be distinguished from elastic recoil, which occurs at the site of balloon injury due to passive elastic properties of the artery, generally immediately after balloon deflation. The contribution of a variety of messengers generated by humoral, neurogenic, myogenic, and endothelium-derived factors in this regulatory process has been implicated. The possible mechanisms of post-percutaneous transluminal coronary angioplasty vasoconstriction at the dilated site (local) and in segments of coronary artery beyond the dilated site (distal) are reviewed in this article.     

Will emergency coronary bypass grafting after failed elective percutaneous transluminal coronary angioplasty prevent myocardial infarction?

An emergency aorto-coronary bypass grafting operation was performed within 12 hours after the development of acute myocardial ischemia due to partial or complete vascular occlusion in 34 of 950 (3.6%) patients who had received elective percutaneous transluminal coronary angioplasty (PTCA). Of the 34 patients, three (= 8.8%) died postoperatively in irreversible cardiogenic shock. Half of the surviving patients developed a Q-wave infarction after the operation, whereas the other half remained without transmural infarct. With comparable clinical data and times of operation up to placement of the aorto-coronary bypass vessel, an adequate residual perfusion must still have been present in the cases with non Q-wave infarction. Since in many cases a myocardial necrosis is unavoidable despite relatively early operative revascularization, the decisive role will be played by the remaining perfusion of the vessel concerned and any collaterals. It follows that treatment of an early PTCA complication, occurring in the catheter laboratory, ought to be the earliest possible aorto-coronary bypass operation unless available cardiological methods can reliably assure reperfusion. Treatment of a PTCA complication occurring later, however, e.g. after hours in the intensive-care unit, should be a repeat PTCA attempt: surgery at this stage will not prevent the transmural infarction but will increase risk of lethal complications.     

用声学密度定量技术早期评价急性心肌梗死患者直接经皮冠状动脉腔内成形术的疗效

目的　探讨利用声学密度 (AD)定量技术早期评价急性心肌梗死 (AMI)患者行直接经皮冠状动脉腔内成形术 (PTCA)的手术疗效。方法　将 4 0例AMI患者分为两组 :18例病人行直接PTCA治疗 (A组 ) ,2 2例病人用药物治疗 (B组 ) ,比较两组病人在入院第 7天时常规超声心动图检查和用AD技术检测的结果。结果　两组病人常规超声心动图各项检查结果比较差别无显著性 (P >0 0 5 )。AD定量检测结果 :A组的背向散射积分周期变化幅度 (CVIB) (4 2± 1 3)dB明显高于B组 (2 5± 2 4 )dB(P <0 0 1) ;A组校正的周期变化延迟时间 (N Delay) 1 0 9± 0 0 8明显低于B组 1 31± 0 16 (P <0 0 1) ;两组间背向散射积分 (IBS)差异无显著性 (P >0 0 5 )。结论　AD技术能够早期反映AMI再灌注心肌的组织学特征 ,为早期评价介入治疗效果、预测心功能改善情况、判定心肌活性提供了一种新的技术手段。     

Coronary artery rupture during transluminal coronary recanalization and angioplasty in a case of acute myocardial infarction and shock

Percutaneous transluminal coronary angioplasty (PTCA) is a widely performed and effective therapy for coronary artery disease. Evolution of the dilatation instruments during the last decade has led to an increased success rate of PTCA and to the development of newer techniques such as recanalization of totally occluded coronary arteries. We report a case of coronary artery recanalization complicated by fatal coronary artery rupture.