摘要
目的探讨静脉桥血管急性闭塞所致急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者给予静脉溶栓治疗的疗效。方法对2019年华北理工大学附属医院收治的1例静脉桥血管急性闭塞所致的急性STEMI患者的临床资料进行回顾分析。患者男性,58岁,12年前行冠状动脉旁路移植术(coronary artery bypass grafting,CABG),因急性下壁STEMI 4 h再次入院,即刻给予阿司匹林0.3 g嚼服,替格瑞洛180 mg口服,肝素注射液4000 U静脉注射,给予重组尿激酶原50 mg静脉溶栓。通过观察胸痛症状的缓解、心电图ST段回落、心肌酶峰前移判定溶栓成功,择期行冠状动脉造影观察原位冠状动脉及桥血管病变情况,制定进一步治疗策略,心脏超声检查了解心脏结构和功能,随访1年,观察有无心绞痛发作及心血管事件。结果溶栓1 h时成功,急性下壁STEMI后第8天行冠状动脉造影检查,罪犯血管为升主动脉-大隐静脉-右冠状动脉,全程弥漫性病变,大量血栓影,原位冠状动脉左主干弥漫性60%狭窄,前降支、右冠状动脉开口完全闭塞,回旋支近段完全闭塞,给予强化抗栓治疗14 d,好转出院。患者急性STEMI后第41天,复查冠状动脉造影,主动脉-大隐静脉-右冠状动脉内血栓影消退,心脏超声显示左心室舒张内径53 mm、射血分数55%,给予改善生活方式,强化药物治疗,心肌梗死后1年,患者无心绞痛发作,能胜任日常工作和生活。结论对于CABG术后>10年的患者,原位冠状动脉慢性闭塞,发生静脉桥血管闭塞所致急性STEMI时,采用静脉溶栓治疗,符合尽早再灌注治疗的原则,预后良好。
Objective To explore the effect of intravenous thrombolysis in patients with acute ST segment elevation myocardial infarction(STEAMI)caused by acute occlusion of venous bridging vessels.Methods The clinical data of a patient with acute STEMI caused by acute occlusion of venous bridge in the North China University of Science and Technology Affiliated Hospital in 2019 was retrospectively analyzed.A 58-year-old male patient underwent coronary artery bypass grafting(CABG)12 years ago.He was re-admitted to the hospital due to acute inferior ST-segment elevation myocardial infarction for 4 hours.He was given Immediately aspirin 0.3 g chewed,ticagrelor 180 mg orally,heparin 4000 U intravenous injection.Next,he was given 50 mg of recombinant prourokinase intravenous thrombolysis.The successful thrombolysis was judged by observing the relief of chest pain symptoms,the ST segment of ECG falling down and the moving of myocardial enzyme peak.Coronary angiography was performed to observe the pathological changes of coronary artery and Bridge in situ,and further treatment strategies were formulated.Cardiac ultrasound examination was performed to understand the structure and function of the heart.The patients were followed up for 1 year to observe whether there were angina pectoris and cardiovascular events.Results Thrombolytic therapy was successful at 1 hour.Coronary angiography was performed on the 8th day after acute inferior STEMI.The culprit vessel was ascending aorta great saphenous vein right coronary artery.The whole course was diffuse lesions with a large number of thrombus shadows.In situ,the left main coronary artery was diffuse 60%stenosis,the ostia of anterior descending branch and right coronary artery were completely occluded,and the proximal part of circumflex artery was completely occluded.The patients were given intensive antithrombotic therapy for 14 days,and he got better and was discharged.On the 41st day after acute STEMI,coronary angiography was reexamined.Thrombus shadow in aorta great saphenous vein right coronary artery disappeared.Echocardiography showed that left ventricular diastolic diameter was 53 mm and ejection fraction was 55%.The patient was given improved lifestyle and intensive drug treatment.One year after myocardial infarction,the patient had no angina pectoris and was competent for daily work and life.Conclusion For patients more than 10 years after CABG,with chronic occlusion of coronary artery in situ,when acute STEMI caused by venous bridge occlusion,intravenous thrombolytic therapy is in line with the principle of early reperfusion treatment and has a good prognosis.
作者
赵红
顾定伟
廖志月
龙啸
Zhao Hong;Gu Dingwei;Liao Zhiyue;Long Xiao(Department of Cardiology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)
出处
《中国综合临床》
2020年第5期435-439,共5页
Clinical Medicine of China
基金
河北省医学科学研究课题计划项目(20201029)。
