568例急诊冠状动脉造影的临床体会

摘要

Objective　To test the safety and feasibility of acute coronary artery angiography in patients (pts) with acute coronary syndromes (ACS). Methods　From Jan. 1996 to Dec. 1999, 568 pts with ACS were performed acute coronary artery angiography. Among which 416 were suspected acute myocardial infarction (AMI), 152 were unstable angina pectoris (UAP). Results　In 416 pts with suspected AMI, 328 underwent primary percutaneous transluminal coronary angioplasty (P-PTCA)±stent for IRAs(infarct related artery) stenosis≥75% and/or ≤TIMI 2, 32 received medicine because IRAs stenosis<75% and TIMI 3, 28 underwent emergency coronary artery bypass graft (CABG) for TVD (triple vessel disease) and/or LMCA(left main coronary artery) stenosis, 8 underwent intravenous thrombolysis for IRAs can not be determined, 17 received conservative treatment because IRAs were too thin to revasculize in 4 pts and IRAs were “normal" in 13 pts. In 152 pts with UAP, 108 underwent P-PTCA±stent for crime vessels stenosis≥75% and/or ≤TIMI 2, 33 underwent emergency CABG for TVD and/or LMCA stenosis, 8 received medicine because crime vessels were “normal”, 2 received IABP (intra-aortic balloon pump) assistance because of diffused lesions in crime vessels. Two pts with AMI and one with post-infarct angina died from ventricular fibrillation and acute left ventricular failure during or immediate after the procedures. Conclusion　Acute coronary artery angiography in pts with ACS is necessary and can be safely performed in clinical practice.%目的评价对急性冠状动脉综合征患者施行急诊冠状动脉造影的安全性与有效性。方法自1996年1月至1999年12月，我们共施行急诊冠状动脉造影568例，其中疑诊急性心肌梗死416例，疑诊不稳定性心绞痛152例。结果 416例拟诊急性心肌梗死病例中，有328例施行了梗死相关血管的直接经皮冠状动脉腔内成形术(Primary PTCA, P-PTCA)治疗；有32例造影发现冠状动脉梗死相关血管直径狭窄<75%，前向血流TIMI Ⅲ级，未行P-PTCA治疗；有12例左主干和(或)三支血管病变患者施行急诊冠状动脉旁路移植术（CABG）；16例左主干和(或)三支血管病变患者在主动脉内球囊反搏(IABP)辅助下，行择期CABG治疗；有8例因梗死相关血管不能确定或是不适宜P-PTCA或CABG病例接受了冠状动脉内溶栓治疗，有4例梗死相关血管细小，未行特别处理；有13例急诊冠状动脉造影示结果正常或体表心电图判定的梗死相关血管正常。152例拟诊不稳定性心绞痛患者中行急诊PTCA治疗108例，CABG 33例，动脉造影正常8例，因弥漫性冠状动脉病变不适宜PTCA/CABG治疗，选用IABP短期辅助治疗加药物治疗维持2例。2例急性心梗和1例梗死后心绞痛患者死于术中或术后即刻。结论对于急性冠状动脉综合征患者施行急诊冠状动脉造影是必要的和安全可行的。