急诊经皮冠状动脉介入治疗急性心肌梗死围术期死亡因素分析

目的 分析急性心肌梗死患者行急诊经皮冠状动脉介入治疗(PCI)围术期死亡原因。方法 回顾性分析2004年3月至2011年3月连续入院接受急诊介入治疗的473例急性心肌梗死患者资料。分析围术期死亡患者的临床特征、急诊PCI结果及死亡原因。 结果 死亡18例(3.8％)，均为ST段抬高型心肌梗死。3支病变8例,2支病变5例，单支病变2例，左主干病变3例；死亡原因：心原性休克9例(50.0％)，心脏破裂4例(22.2％),无复流2例(11.1％),上消化道大出血致休克、慢性阻塞性肺疾病并发重症肺炎死于呼吸衰竭、顽固性心室颤动各1例(5.6％)。 结论急性心肌梗死急诊PCI围术期心原性休克、心脏破裂为主要死亡原因。多支病变、并存高血压、糖尿病等可能为死亡的危险因素。

Reasons for perioperative death in treatment of acute myocardial infarction by emergent percutaneous coronary intervention

Objective To analyze the dead reasons in treatment of acute myocardial infarction (AMI) by emergent percutaneous coronary intervention (EPCI) during perioperation. Methods The clinical characteristics of the dead patients, results of EPCI and reasons of death were retrospectively analyzed in 473 patients with AMI who received EPCI treatment during March 2004 to March 2011. Results Among the 18 cases(3.8％)dead patients,there were 8 case with three-vessel lesions,5 cases with two-vessel lesions, 2 cases with single vessel lesion and 3 cases with left main lesion. Nine patients were accompanied with hypertensions,5 cases with diabetes mellitus, 1 case with old myocardial infarction, 2 cases with old cerebral infarction, 1 case with chronic obstructive pulmonary disease complicated by severe pneumonia, and 1 case with chronic renal insufficiency. Nine patients died of cardiogenic shocks , 4 cases (22. 2％) of heart ruptures, 2 cases (11.1％) of noreflow,1 case (5.6％) of massive hemorrhage of the upper alimentary tract, 1 case (5.6％) of respiratory failure and 1 cases (5.6％) of refractory ventricular fibrillation.Conclusions Primary reasons for perioperative death were cardiac shock and heart rupture in treatment of acute myocardial infarction by EPCI. Multi-vessel lesion, complications with hypertensions and diabetes mellitus may serve as succumbed factors of death.