冠状动脉左主干病变并急性缺血事件的处理及预后

目的观察主动脉内球囊反搏（ＩＡＢＰ）对冠状动脉左主干严重病变合并急性缺血事件病人的临床应用价值。方法回顾性研究了严重左主干病变（狭窄＞７０％）病人的临床预后。结果在１７０１例冠状动脉造影中，新发现严重左主干病变为２３例（１３５％）；１７例（７４％）在冠状动脉造影后，没有急性心肌缺血表现，其中５例预防性植入了ＩＡＢＰ；６例（２６％）在冠状动脉造影中或后伴有不同程度的急性心肌缺血表现，其中４例及时植入了ＩＡＢＰ；这些病人均成功地接受了冠状动脉搭桥术（ＣＡＢＧ），手术成功率为１００％，无住院期间死亡；４例有心肌缺血表现的病人，随访６～１０个月仍存活。另２例伴有急性缺血表现的病人，未能及时成功地植入ＩＡＢＰ，１例抢救性ＣＡＢＧ术后１２小时死亡，１例抢救性支架术后１２小时死亡。结论严重左主干病变，特别是伴有急性心肌缺血表现者，立即植入ＩＡＢＰ，能迅速改善心肌灌注，病人有更多机会接受血管再通治疗，否则病人预后极差。

Emergent treatment and progosis of patients with severe left main coronary stenosis and acute cardiac ischemic events

Objective Observing the affection and effectiveness of intra-aortic Balloon Pump (IABP) on patients with severe left main coronary stenosis and acute cardiac ischemic events. Methods Respectively studied the clinical prognosis of all patients with severe left main coronary disease with or without acute ischemic events. Results1701 coronary angiograms were completed during June, 1997June,1998. New found patients with severe left main coronary disease (stenosis70% in diameter) were 23 cases. In 5 of 17 patients without acute cardiac ischemic events during of just after coronary angiography, IABP was inserted prophylactically; 4 of 6 patients with acute cardiac ischemic events during of just after coronary angiography, IABP was inserted immediately; They all got successful coronary artery bypass graft(CABG);there was no different in operation success rate, hospital stay and in-hospital death between these patients with or without acute ischemic events; And 4 patients with ischemic events were all alive during following-up of 610 months. Another two patients with acute ischemic events, who did not get successful IABP insertion when they got cardiac ischemic manifestations, all died in 24 hous in hospital. although one performed rescue CABG, one did rescue left main stenting. Conclusions Severe left main coronary stenosis was common finding angiographically. These patients, especially those with cardiac ischemic events during or after coronary angiogram, insertion of IABP immediately and successfully could quickly improve perfusion of coronary artery and the patients may have more chances to get coronary revascularisation, otherwise, the patients may die.