急性心肌梗塞病患未接受緊急經皮冠狀動脈氣球擴張術之原因及預後之探討

The Causes and Clinical Outcomes in Acute Myocardial infarction Patients without Primary PTCA

許育誠(Yu-Cheng Hsu) ； 程俊傑(Jun-Jack Cheng) ； 李世煌(Shih-Huang Lee) ； 徐國基(Kou-Gi Shyu) ； 林申昌(Shen-Chang Lin) ； 洪惠風(Huei-Fong Hung) ； 劉哲仰(Jer-Young Liou) ； 管培良(Peliang Kuan)

《中華民國急救加護醫學會雜誌》 11卷1期 (2000/03) Pp. 10-15

https://doi.org/10.30018/JECCM.200003.0002

摘要

急性心肌梗塞最初的治療目標在於使梗塞的血管儘速獲得血液灌流。本研究單位對急性心肌梗塞病患的治療政策是儘可能施行緊急經皮冠狀動脈氣球擴張術，但仍有許多的病患並未接受此手術。從1992年10月至11月，我們搜集了645位在本院診斷為急性心肌梗塞的病患。包括503位男性及151位女性，他們的平均年齡是64±10.7歲，平均追蹤期為18.5±12.5個月，其中有412位(63%)並未接受緊急經皮冠狀動脈氣球擴張術。而這412位病患包括260位(63%)Q波心肌梗塞；152位(27%)為非Q心肌梗塞。其Killip分類如下，Killip∣：187位(45%)；KillipⅡ：75位(18%)；KillipⅢ：62位(15%)；KillipⅣ：72位(18%)；其他未確定分類：16位(4%)。對急性心肌梗塞未接受緊急經皮冠狀動脈氣球擴張術的病患，最常見的原因包括症狀發生到就醫時間的延誤、延遲診斷、病患接受溶血栓治療。其他的原因包括不穩定的病患情況、有經驗的心臟科醫師及技術人員無法即時趕到、通暢的冠狀動脈及其他如經皮冠狀動脈氣球擴張不合適等。這些病患住院中死亡率為24%(99/412)，整體死亡率高達30%(124/412)。我們的結論為急性心肌梗塞的病患未接受緊急經皮冠狀動脈氣球擴張術有的預後較差，而未作緊擴張術最常見的原因為延遲抵達醫院。

關鍵字

急性心肌梗塞 ； 預後 ； 緊急經皮冠狀動脈氣球擴張術

並列摘要

The primary goal of treatment in acute myocardial infarction(AMI) is reperfusion of the infarctrelated partery as soon aas possible. In our hospital,proper facilities with an experienced team are available and primary angioplasty is our policy to treat the patients with AMI. However, there were still a lot with AMI diagnosed in our hospital from Oct.1992 to Nov.1998. There were 503 men and 151 women. Their mean ages were 64±10.7yaer. The mean follow-up period was 18.5±12.5 months.There were 412patients who did not undergo primary PTCA(Q wave MI in 260, non-Qin 152; Killip classification∣：187, Ⅱ：75, Ⅲ：62, Ⅳ：72 patients, respectively). The causes of the AMI patients without primary PTCA included prolonged onset-ER time(113/412,27.4//5),delayed diagnosis(96/412,23.3%),thrombolytic therapy performed(92/412.22.3%),poor patients condition(56/412,13.6%), experienced staff unavailable(12/412,2.9%), andpatent coronary artery(8/412,1.9%). The clinical outcomes were relatively poor in the AMI partients without primary PTCA (99 patients died in hospital, 17 within 1 year, another 8 during the follow-up). The overall mortality in this group was 30%(124/412). In conclusion, one of the major causes of the AMI patients without primary PTCA was prolonged onset-ER time, and the whole group had a rather poor prgnosis.

並列關鍵字

acute myocardial infarction ； prognosis ； primary PTCA