急性心肌梗塞冠脉内溶栓与支架术疗效的比较_牟春平

度以内),无瓣膜的器质性病变,可以单纯封堵

PDA ,无需处理瓣膜问题,术后随着血流动力学的改善,瓣膜问题可自行好转。本组8例合并二尖瓣轻-中度关闭不全和4例合并主动脉瓣轻度狭窄的患儿,3个月后复查二尖瓣和主动脉瓣,均未发现有血流动力学意义的关闭不全及狭窄。

并发症:介入封堵PDA 的并发症,包括残余分流、医源性主动脉和肺动脉狭窄、溶血、血栓形成及封堵器脱落等[6]

。婴幼儿选择偏小的封堵器,易造成残余分流、溶血和封堵器脱落,太大则易造成医源性主动脉和肺动脉狭窄,选择大小合适的封堵器需要经验的积累。本组1例封堵器选择偏小,加上释放后封堵器部分向主动脉侧回缩,术后出现中量残余分流而转外科手术治疗。低龄患儿,周围血管纤细,术后发生血管并发症的机会较高。本组1例患儿术后患肢股动脉搏动减弱,下肢侧呈花斑样改变伴皮温降低,考虑血栓栓塞,经抗凝及对症处理后恢复正常。1例患儿术后出现伤口出血,未及时发现,出血量较大,最后经输血治疗后方好转。总体来说,婴幼儿期PDA 的介入治疗是一种较为安全有效的方法,但应该严格把握手术适应症,

并且由有丰富经验的儿科导管医师指导操作。对于K richenko C 型和窗型及PDA >5mm 的婴幼儿,应慎重选择介入治疗或外科手术。参考文献:

[1]中华儿科杂志编辑委员会,中华医学杂志英文版编辑委员会.

先天性心脏病经导管介入治疗指南[J ].中华儿科杂志,2004,42(3):234-239.

[2]Robert H .M ulticenter US A Amplatzer patent du ctus arterios us

occlusion device trial [J ].J Am Coll Cardiol ,2004,44:513-519.[3]黄建波,周建华,袁战军.介入治疗先天性心脏病118例近期

疗效评价[J ].心血管康复医学杂志,2008,17(1):52-54.[4]Krichenko A ,Benson LN ,Burrow s P ,et al .Angiograp hic

clas sification of the isolated persis tently patent ductu s arterious and implication for percutaneous catheter occlu s ion [J ].Am J Cardiol ,1989,63:877-800.

[5]Faella H J ,H ijazi ZM .Closure of the patent ductu s arterios us

w ith the Amplataer PDA device :imm ediate results of the in ter -national clinical trial [J ].Cardiovas cul Intervent ,2000,51(1):50.

[6]M asu ra J .Cath eter closure of m oderate -to large -sized patent du c -tus arteriosu s u sing new Amplatzer duct occluder :immediate and s hort -term resu lts [J ].J Am coll Cardiol ,1994,23:1666-1670.

(收稿日期:2008-05-24)

急性心肌梗塞冠脉内溶栓与支架术疗效的比较

作者单位:佳木斯大学附属第一医院心内科,黑龙江佳木斯市　154002

牟春平,杨光远,张洪亮,马振晶

摘要:目的:观察急性心肌梗塞患者冠脉内溶栓及急诊置入支架术的效果。方法:根据冠状动脉造影资料,50例病人中,33例成功支架植入为支架组;17例不适合或支架失败者为冠脉内溶栓组,经导管注入50万单位尿激酶至梗塞相关血管,术中监测T IM I 血流,再灌注性心律失常,心电图及心肌酶和心功能。结果:血管开通率,支架组达到97%,冠脉内溶栓组只达到59%,两组差异有显著性(P <0.05)。结论:植入支架是急性心肌梗塞患者恢复心肌血流灌注的最好方法。对于不适合植入支架者,冠脉内溶栓也是一种值得应用的方法。关键词:心肌梗塞;支架;血栓溶解疗法文章编号:1008-0074(2008)04-0386-03

中图分类号:R542.22

文献标识码:A

Ef fectiveness of coronary artery thrombolysis and emergency stenting in patients with acute myocardial infarction /M OU C hun -ping ,YA NG Guang -yuan ,ZHANG Hong -liang ,MA Zhen -jing //C hinese Journal of C ardiovascular Rehabilitation Medicine ,2008,17(4):386

A bstract :Objective :Effectiveness o f co ro nary ar ter y thro mbo ly sis and emerg ency stenting in patients w ith acute myo -car dial infarctio n (A M I ).Methods :T he 33A M I pa tients accepted co ronary ang io gr aphy and stent implantatio n (stent gr oup );17ca ses (co ronary thro mbo ly sis gr oup )we re trea ted with inject 500000units of urokinase to the in -fa rction related a rtery (IRA ).T he mo nito r of repe rfuso n arr hy thmia ,electr ocardiog r am ,my ocardial enzy me ,T IM I changes on blo od f low a nd hear t functio n w as pe rfor med in all subjects .Results :P atent r ate of I RA wa s 97.0%in stent g ro up ,it w as more than that of co ro na ry thro mbo ly sis g ro up (59%),P <0.05.Conclusion :Stenting is the