非开胸法建立室壁瘤动物模型的实验研究

目的　探讨运用PTCA球囊封堵猪冠状动脉建立急性心肌梗死后室壁瘤的动物模型的实验方法。方法　选用家猪 7只 ,麻醉后经颈总动脉或股动脉置入PTCA球囊至左前降支 (LAD)第一对角支远端 ,对堵血流 15 0分钟。观察 :心电图、心肌酶、心脏二维超声检查及冠状动脉和左心室造影。结果　 7只猪均完成LAD的封堵 ,2只分别在堵闭 12 0分钟和 2 0分钟后因心室纤颤死亡。存活的 5只猪成功建立左室前壁急性心肌梗死模型 ,术后 6周造影复查示左室前壁、心尖部室壁瘤形成 ,4只猪堵闭的LAD远端闭塞。心电图显示急性心肌梗死的典型图形和动态演变过程。cTnI明显升高并呈动态演变。术后 1小时超声检查出现间隔上部及前壁局部运动异常 ,术后 2周即有室壁瘤形成。结论　运用PTCA球囊封堵冠状动脉可成功建立急性心肌梗死后室壁瘤的动物模型 ,与开胸法相比更接近人体的状态 ,具有创伤小、动物成活率高、生存时间长、技术要求不高等优点 ,可为进一步的研究提供较好的实验模型。     

应用开胸法建立室壁瘤动物模型

用杂种犬10只,麻醉后左侧开胸,结扎左前降支（LAD）及其第二对角支,5周后行心脏二维超声检查以明确室壁瘤形成效果。结果为10只犬均完成冠状动脉结扎手术,1只房室收缩分离术中死亡,1只心室纤颤术中死亡。存活的8只均成功建立了左室急性心肌梗死后室壁瘤的动物模型。心脏二维超声检查示左室前壁、心尖部室壁瘤形成。认为应用开胸法结扎冠状动脉可以成功建立急性心肌梗死后室壁瘤的动物模型。     

冠状动脉堵闭法建立猪心肌梗死模型

探讨运用经皮腔内冠状动脉成形术球囊堵闭猪冠状动脉建立急性心肌梗死动物模型的实验方法。选用苏中幼猪11只，麻醉后经股动脉或颈总动脉置入经皮腔内冠状动脉成形术球囊至冠状动脉左前降支远端，堵闭血流120min。观察心电图、心肌酶、心脏二维超声检查及冠状动脉和左心室造影。结果发现，存活7只猪均完成冠状动脉左前降支远端的封堵，心电图显示急性心肌梗死典型图形变化，血浆肌钙蛋白明显升高并呈动态演变：术后1h超声检查出现间隔上部及前壁局部运动异常；术后2至4周造影复查显示左心室前壁、心尖部心室壁异常运动；存活7只猪均成功地建立急性心肌梗死模型。另4只猪分别在堵闭60～100min因心室纤颤死亡。结果提示，运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗死模型，并保持封堵冠状动脉通畅；与开胸法相比更接近人体状态，具有创伤小、动物生存时间长并易于术后馒头等优点。     

非开胸法建立持续性单形性室性心动过速动物模型的研究

探讨运用经皮球囊冠状动脉成形术 (PTCA)球囊堵闭猪冠状动脉造成急性心肌梗死 (AMI)后数周建立持续性单形性室性心动过速 (VT)的非开胸法动物模型的方法。猪 1 3只 ,体重 30± 5kg ,运用PTCA球囊堵闭猪左前降支(LAD)形成AMI。存活猪在AMI后数周内进行心室程序电刺激诱发持续性单形性VT ,观察VT诱发、终止的方式及VT诱发的时间窗等。结果 :9/ 1 3只猪形成AMI,经左心室造影及心脏超声检查证实左室心尖、前间隔、左室前壁室壁瘤形成。术后 2～ 2 0周内 9只猪接受平均 1～ 2次电生理检查 ,运用程序电刺激方法 ,8只猪共成功诱发出 1 6种单形性持续性VT ,1只猪仅诱发出非持续性短阵VT。VT周长为 2 54± 65ms ,持续时间 1 8± 1 6min,最长达 62min。程序电刺激和直流电复律可终止VT ,1 0种VT表现为室房分离 ,6种VT室房均为 1∶1逆传 ;9种呈左束支阻滞型 ,7种呈右束支阻滞型。结论 :运用PTCA球囊堵闭冠状动脉造成MI后室壁瘤形成 ,通过程序电刺激的方法可成功建立持续性单形性VT非开胸动物模型 ,成功率较高 ,VT诱发的时间窗长。     

尼沙赫电图对早期心肌缺血的预先诊断价值探讨

目的 建立中国中型猪经皮冠状动脉腔内血管成形术(PTCA)球囊封堵冠状动脉急性心肌梗死模型,研究急性心肌缺血梗死过程中尼沙赫电图(saahECG)时间轴心室测量标量参数S-VS和VS-VD的变化,并探讨该变化对心肌缺血的早期诊断价值.方法 中国中型猪,体重39~67(44.5±12.70)kg,麻醉后经股动脉置入PTCA球囊至左前降支第一对角支远端,堵闭血流120 min,同步、逐波扫描记录模型建立前后及过程中saahECG和常规12导联心电图(ECG),随后对saahECG时间轴心室测量,以S-VS和VS-VD作为标量参数进行分析,并与同步记录的ECG对比分析.结果 ①运用PTCA球囊封堵法成功建立猪急性心肌梗死模型,球囊封堵12 s后saahECG即出现VS-VD改变,39 s后S-VS显著增加,而ECG的ST段改变则于24 s后出现.②saahECG心室时间轴标量参数S-VS、VS-VD改变早于心电图改变.③ 球囊封堵前及封堵2 h后,saahECG标量参数S-VS、VS-VD差异显著.结论 我们发现了一种新的监测心肌缺血的体表心电图,即saahECG,saahECG比ECG提前反应,并可以实现心肌缺血改变的数据化显示,对心肌缺血更早期的诊断有重要价值.     

经皮球囊扩张封堵冠状动脉前降支制备巴马香猪急性心肌梗死模型

目的 探讨经皮球囊扩张封堵冠状动脉前降支(LAD)制备巴马香猪急性心肌梗死(AMI)模型的方法及可行性.方法 经右股动脉置入冠状动脉球囊导管至左前降支;预适应3～4次,每次球囊充盈30 s,间隔5～10 min;以3～5 atm扩张球囊封闭LAD远端血流,40 min后撤除球囊.结果 8头巴马香猪中有6头存活,造模成功率为75%.模型梗死面积变异系数为11.7%(33.2±3.9).封堵后心电图呈动态变化,心肌酶学指标(CK、CK-MB、cTnI、Myo、LDH)较术前明显升高,心脏彩超左心室舒张末内径、左心室舒张末容积及左心室收缩末容积均增大,LVEF均下降,部分实验猪出现心室壁瘤,TTC染色、HE染色证实心肌梗死模型建立成功.结论 经皮球囊扩张封堵法制备巴马香猪急性心肌梗死模型成功率高,保持了梗死区冠脉可重复进行造影,为干细胞植入梗死区心肌治疗AMI提供了较好的动物模型.     

老年大鼠急性心肌梗死模型的制备

目的:建立一种稳定可重复的老年大鼠急性心肌梗死动物模型。方法:老年Wistar雄性大鼠乌拉坦麻醉后,气管切开插管,连通呼吸机,左侧3、4肋间开胸后结扎左冠状动脉前降支,收紧结扎线当时出现前降支支配区域心肌变苍白或发绀,心电图ST段抬高≥0.2 mV或T波高耸形成单峰融合波,提示结扎成功。结果:60只老年大鼠,死亡6只,成功制备54只,模型制备成功率90%,22只出现心室纤颤(室颤),其中3只死亡,室颤发生率36.7%,室颤死亡占总死亡的50%。结论:正确使用麻醉药、顺利气管插管、准确结扎冠状动脉及减少术中出血与肺损伤是制模成功的基础,本文建立的方法简单、有效,为研究老年急性心肌梗死提供了新的手段。     

非开胸法室壁瘤相关持续性单行性室性心动过速动物模型的建立

目的:探讨运用经皮球囊冠状动脉成形术(PTCA)球囊堵闭猪冠状动脉前降支(LAD)造成急性心肌梗死(AMI)后数周,形成左心室室壁瘤(LVA)并结合程序刺激方法,建立持续性单行性室性心动过速(SMVT)的非开胸动物模型。方法:中华实验小型猪7只,体质量(35±5)kg,运用PTCA球囊堵闭猪LAD形成AMI。存活猪在AMI后数周内行心室程序刺激诱发SMVT。术中及术后观察LAD、左心室造影及超声心动图改变,SMVT诱发、终止方式及SMVT周期变化。结果:5只猪证实左心室室壁瘤形成。术后4 w对5只猪行程序刺激,诱发出11种SMVT,周长为(223.63±32.55)ms,且可被程序刺激和直流电复律终止。其中,7种SMVT为房室分离,4种SMVT为室房1:1逆传;8种呈左束支传导阻滞,3种呈右束支传导阻滞。心电图演变过程与人体心肌梗死过程基本一致。结论:运用PTCA球囊堵闭LAD造成AMI后LVA形成,并通过程序刺激成功诱发SMVT。此种非开胸法建立室壁瘤相关持续性单行性室性心动过速动物模型成功率高。研究结果提示,折返可能是室壁瘤相关室性心律失常的电生理基础,为进一步研究治疗奠定了实验基础。     

介入性方法治疗冠心病急性心肌梗死合并室间隔穿孔(附3例报告)

目的　评价Amplatzer肌部室间隔封堵器封堵室间隔穿孔和经皮冠状动脉腔内成形术 (PTCA)及冠脉支架术联合介入方法治疗急性心肌梗死合并室间隔穿孔的可行性、安全性和疗效。方法　 3例患者术前均经超声心动图检查诊断为急性心肌梗死并发室间隔穿孔 ,入院后强化纠正心衰治疗 ,先完成室间隔封堵术 ,再择期完成冠脉PTCA及支架术。结果　 (1)室间隔破裂封堵结果 :分别选用直径为 12mm、10mm和 16mmAmplatzer肌部室间隔封堵伞成功封堵。 1例有少量残余漏。 (2 )冠脉造影及介入结果 :2例为前降支单支 90 %和 95 %狭窄 ,前降支中段分别植入支架 ;另 1例为 3支血管病变 ,前降支中段 10 0 %关闭 ,前降支和右冠脉植入 2枚支架。PTCA及支架术即刻成功率为 10 0 % ,无并发症发生。 (3)近期和远期预后 :3例病人心功能均得到明显改善。 2例于术后 10d出院 ,1例 (3支病变病例 )于术后 4d并发脑血管意外 ,2周后死亡。 1例 1年后复查 ,超声心动图左室内径由 5 7mm降至 5 3mm ,EF由 0 .34增至 0 .5 6 ,室间隔仍有少量残余漏 ;另 1例 6个月复查 ,超声心动图左室内径由 5 6mm降至 5 2mm ,EF由 0 34增至 0 6 2 ,室间隔封堵处无漏血。 2例均无心绞痛 ,心功能 2级。结论　应用Amplatzer肌部室间隔封堵器封堵室间隔穿孔和PTCA及     

家猪急性心肌梗塞模型冠脉零流量压与存活心肌的相关性

目的:探索制备的家猪急性心肌梗塞模型中梗塞相关冠状动脉零流量压(Pzf)与存活心肌面积的关系。方法:普通家猪13只,冠脉造影结束后应用指引导管测量前降支近端压力,置入冠脉内多普勒导丝测量前降支远端冠脉内的血流速度,绘制压力-血流速度坐标轴,计算Pzf。将球囊送至冠状动脉左前降支中远端,堵闭血流60～100min,建立心梗模型。模型建立后重复测算前降支Pzf,分析心梗模型制备前后前降支Pzf数值的变化。处死试验动物,切片心肌采用TTC染色法识别梗塞心肌与存活心肌,采用图像分析仪分析代表存活心肌的颜色占整个左心室面积的百分数,将其与梗塞后前降支Pzf数值联合建立坐标轴,观察二者之间的关系。结果:所有家猪均完成冠状动脉左前降支远端的封堵,2只家猪分别在堵闭45和65min时因心室纤颤死亡。存活11只家猪均成功地建立急性心肌梗塞模型,完成Pzf数值的测算。心梗后前降支的Pzf[(53.06±23.01)mmHg]较心梗前[(40.13±19.53)mmHg]显著升高,P0.001。线性回归分析显示,TTc染色存活心肌占左心室面积的百分数与测得的Pzf值呈负相关(r=-0.879,P0.001)。结论:运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗塞模型,存活心肌的面积与相关血管的零血流量压呈负相关,提示零流量压的测定可以作为预测心梗后存活心肌范围的一个指标。     

慢性冠状动脉闭塞置入支架术与球囊扩张术的比较

目的为了解冠状动脉内支架及经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗完全闭塞性冠状动脉血管的临床及冠状动脉造影效果。方法９５例完全冠状动脉闭塞的病人随机分成为：置入支架组（Ａ组４８例）;单纯ＰＴＣＡ组（Ｂ组４７例）,观察二组病人发生临床事件及６个月后的冠状动脉造影效果。结果６个月后两组病人完成临床及冠状动脉造影随访的共８５例,随访率为８９％,Ａ组４２例,Ｂ组４３例。Ａ组：１例于术后１０天内出现心肌梗塞,无１例死亡,其再狭窄率为２８．５％,血管再闭塞率为１１９％,最终重复血管重建术为１９％。Ｂ组：１例死亡,２例发生急性心肌梗塞,再狭窄率为５８％,血管再闭塞率为２２％,最终重复血管重建术达４５％。两组之间临床疗效差异均有显著性（Ｐ＜０．００１）。结论冠状动脉慢性闭塞的病人ＰＴＣＡ成功后选择性置入支架比单纯ＰＴＣＡ的近期及远期临床疗效预后要好（发生临床事件及重复血管重建术明显下降）。     

Efficacy of percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction complicated by cardiogenic shock.

Cardiogenic shock still remains a highly lethal complication of acute myocardial infarction (AMI). This study reviews our hospital experience in treating AMI complicated by cardiogenic shock to evaluate whether coronary angioplasty improves survival or not. We have treated 523 AMI patients from 1985 to 1990, and among these, 26 patients with AMI complicated by cardiogenic shock who underwent percutaneous transluminal coronary angioplasty (PTCA) compose the study group. In 16 patients, PTCA was successful (Groups S) and in 10 patients, unsuccessful (Group F). There were no statistical differences between the Groups with respect to clinical background, intraaortic balloon counterpulsation (IABP) or emergency coronary bypass graft surgery. Before PTCA, hemodynamic variables including cardiac index, pulmonary capillary wedge pressure and systolic blood pressure were similar in the 2 groups. After PTCA, cardiac index in Group S patients was better than in Group F patients (2.18 +/- 0.61 versus 1.62 +/- 0.65, p less than 0.05). Thirty day and 1 year survivals were also better in Group S than in Group F (30 day survival: Group S 56.2%, Group F 10%, 1 year survival: Group S 31.2%, Group F 0%, p less than 0.05). Multivariate analysis showed that age under 75 years old, systolic blood pressure over 90 mmHg after PTCA and successful PTCA were independent predictors of 30 day survival (p less than 0.05). It was suggested that PTCA was an effective procedure to reduce mortality in patients with cardiogenic shock.     

Outcomes of optimal or "stent-like"balloon angioplasty in acutemyocardial infarction: the CADILLAC trial

OBJECTIVES: We sought to compare outcomes between patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary angioplasty (PTCA) with an optimal or "stent-like" result versus patients who underwent routine stent placement. BACKGROUND: Recent studies in patients with AMI undergoing stent implantation have suggested that PTCA may no longer be a relevant treatment modality for stent eligible lesions. However, whether routine stent placement is superior or necessary when an optimal PTCA or "stent-like" result is achieved is unknown. METHODS: In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 2,082 patients with AMI were randomly assigned to undergo PTCA alone, PTCA + abciximab, stenting alone, or stenting + abciximab. Outcomes were compared in patients achieving an optimal acute PTCA result (residual core laboratory diameter stenosis <30% without significant dissection) versus those assigned to routine stenting. RESULTS: Optimal PTCA was achieved in 40.7% of patients randomized to balloon angioplasty, including 38.5% and 42.7% assigned to PTCA alone and PTCA + abciximab, respectively. Ischemic target vessel revascularization (TVR) at 30 days occurred more frequently after optimal PTCA than routine stenting (5.1% vs. 2.3%, p = 0.007). The one-year composite adverse event rate (death, reinfarction, disabling stroke, or TVR) was greater after optimal PTCA than routine stenting (21.9% vs. 13.8%, p < 0.001), driven largely by increased rates of ischemic TVR (19.1% vs. 9.1%, p < 0.001); no significant differences were present in the rates of death, reinfarction, or disabling stroke between the two groups. Angiographic restenosis also was more common with optimal PTCA than routine stenting (36.2% vs. 22.2%, p = 0.003). Even a post-PTCA diameter stenosis of <20% (realized in 12% of patients) did not result in outcomes equivalent to stenting. CONCLUSIONS: Even if an optimal result is achieved after primary PTCA in AMI, early and late outcomes can be further improved with routine stent implantation.     

主动脉内球囊反搏术临床应用(附64例报告)

目的研究主动脉内球囊反搏术(IABP)在急性心肌梗死(AMI)并发心源性休克患者临床运用效果.方法64例AMI伴心源性休克患者,在内科治疗的基础上进行IABP治疗.机器为Datascope system97E型反搏仪,均采用40ml型球囊导管,反搏持续时间为24～144h,经在IABP支持下,64例中62例进行急诊经皮冠状动脉成形术(PTCA)和支架术,2例进行急诊冠状动脉旁路移植术(CABG).结果64例患者中死亡18例,病死率为29.7%.结论IABP支架下,积极进行血管重建治疗方能降低病死率.     

Percutaneous transluminal coronary angioplasty. A report of 100 cases

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 100 coronary heart patients with 122 vessels and 138 lesions dilated. Among these 100 cases, there were 39 complex PTCA performed. The primary success rate was 93% (93/100), was 94.3% (115/122) according to vessel dilated and was 92.1% (127/138) according to lesion dilated. In 4 cases whose lesions were located at the bifurcation of the vessel, kissing balloon technique via a single guiding catheter was applied with success. In 5 cases of total occlusion PTCA was performed with success in 4. PTCA with stent in 1. PTCA was performed in 1 cases of high risk whose LVEF was only 30% and coronary hemoperfusion pump was used during the procedure. Emergency PTCA was performed in 3 AMI patients during the acute phase and elective PTCA in 8 AMI cases after successful thrombolytic therapy. There were complications in 9 cases (9%). Among these 9 cases, 2 developed O-wave MI which recovered after medicinal therapy. One AMI complicated with heart failure was treated by emergency PTCA with success, but the patient died 10 days after PTCA due to pump failure and pulmonary infection. There were no deaths due to PTCA, nor was emergency coronary artery bypass graft (CABG) performed. These cases were followed for 1-30 months on an average of 13 months. Clinical success rate was 91.3%. The clinical success rate was 93.1% by 201Tl perfusion study. Restenosis in 7 cases was confirmed by coronary angiography. For these restenotic cases, PTCA was repeated with success in 4, CABG performed in 1, coronary atherectomy in 1, and medicinal therapy employed in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

A randomized trial comparing myocardial salvage achieved by coronary stenting versus balloon angioplasty in patients with acute myocardial infarction considered ineligible for reperfusion therapy

OBJECTIVES: We assessed myocardial salvage achieved by reperfusion with percutaneous coronary interventions (PCI) and compared stenting with balloon angioplasty (PTCA) in patients with acute myocardial infarction (AMI) ineligible for thrombolysis. BACKGROUND: A substantial proportion of patients with AMI are currently considered ineligible for thrombolysis, and reperfusion treatment is frequently not recommended for them. It is not known whether these patients benefit from PCI. METHODS: The Stent or PTCA for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Ineligible for Thrombolysis (STOPAMI-3) trial, a randomized, open-label study, included 611 patients with AMI who were ineligible for thrombolysis (lack of ST-segment elevation on the electrocardiogram, late presentation >12 h after symptom onset, and contraindications to thrombolysis). Patients were randomly assigned to receive either coronary artery stenting (n = 305) or PTCA (n = 306). Scintigraphic myocardial salvage index (proportion of the initial myocardial perfusion defect that was salvaged by reperfusion) was the primary end point of the study. RESULTS: A considerable myocardial salvage was achieved with both stenting and PTCA. In patients assigned to receive stenting, the median size of the salvage index was 0.54 (25th and 75th percentiles, 0.29 and 0.87), as compared with a median of 0.50 (25th and 75th percentiles, 0.26 and 0.82) in the group assigned to receive PTCA (p = 0.20). Mortality at six months was 8.2% in the group of patients assigned to receive stenting and 9.2% in the group of patients assigned to receive PTCA (p = 0.69). CONCLUSIONS: Patients with AMI who are currently considered ineligible for thrombolysis by conventional guidelines may greatly benefit from primary PCI. The benefit seems to be comparable when a strategy of stenting is compared with a strategy of PTCA in these patients.     

经皮冠状动脉腔内成形术在急性心肌梗死治疗中的应用

目的　观察经皮冠状动脉腔内成形术 (PTCA)在老年人急性心肌梗死治疗中的安全性和临床疗效。　 方法 　对 36例老年急性心肌梗死的患者行PTCA或PTCA加支架治疗。　 结果　 36例急性心肌梗死患者中 14例行直接PTCA ,5例补救PTCA ,17例择期PTCA。 36例手术成功 33例 ,术后TIMI血流均获 3级以上 ,失败 3例。有16例置入冠脉内支架 2 1枚 ,住院期间死亡 2例。　 结论　PTCA是治疗老年人急性心肌梗死的安全有效的方法 ,可降低急性期死亡率。     

急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗     

Relation between coronary thrombus and angiographic no-flow during primary angioplasty in patients with acute myocardial infarction

No flow is an unsolved issue in primary percutaneous transluminal coronary angioplasty (PTCA) for patients with acute myocardial infarction (AMI), and the pathophysiology of no-flow is undetermined. To evaluate the potential participation of coronary thromboembolism in no-flow during primary PTCA, the present study reviewed cinefilms of 256 consecutive patients who underwent primary PTCA for AMI within 24h after the onset of chest pain between January 1992 and June 1998, focusing on the thrombus size. Angiographic no-flow was defined as the cessation of flow into the distal coronary circulation of the treated vessel with a to-and-fro contrast movement, not attributable to high-grade stenosis or spasm of the original target lesion. The coronary thrombus size was determined by using the 2-cm balloon catheter as a reference after crossing the infarct-related occluded artery with a guide wire. Angiographic no-flow was observed in 37 patients (37/256, 14%): 14 of 29 cases (48%) with a large thrombus (> or =2cm) versus 23 of 227 cases (9%) with a small thrombus (<2cm, 14/29 vs 23/227, p<0.01). Among 37 patients who experienced angiographic no-flow, overt distal emboli were observed in 14 patients. A thrombolytic agent was used through a guiding catheter in 102 cases prior to or after balloon dilatation to prevent or attenuate distal embolism, particularly in all those cases with a large thrombus (29/29 100%), and angiographic no-flow was seen in 27 cases of this subgroup (27/102, 26%). It is suggested that distal thromboembolism plays an important role in the mechanism of angiographic no-flow during primary PTCA performed for AMI.     

急性心肌梗塞经皮腔内冠状动脉成形术——球囊导管类型与再灌注心律失常

分析97例急性心肌梗塞(AMI)患者接受直接经皮腔内冠状动脉成形术(PTCA)治疗时,不同类型球襄导管与再灌注心律失常(RA)的关系.普通球襄导管组心律失常的总发生率为55.4%,而灌注式球囊导管组心律失常的发生率仅为34.4%,且心律失常的严重程度远较普通球囊导管组为轻.直接PTCA时,灌注式球囊导管能降低RA的发生率及其严重程度.