Safety and Efficacy of Primary Percutaneous Transluminal Coronary Angioplasty for Acute Myocardial Infarction Complicated by Prolonged Cardiopulmonary Resuscitation

直接冠状動脈氣球擴張術對急性心肌梗塞併發院外心跳停止病人的安全及療效

連楚明(Aming Chor-Ming Lin) ； 徐國基(Kou-Gi Shyu) ； 程俊傑(Jun-Jack Cheng) ； 管培良(Pei-Liang Kuan) ； 張珩(Hang Chang)

《中華民國急救加護醫學會雜誌》 9卷4期 (1998/12) Pp. 145-151

https://doi.org/10.30018/JECCM.199812.0002

摘要

爲了砰估直接冠状動脉氣球擴張術對急性心肌梗塞病人併發院外心跳停止的安全性及療效，在五年期間，我们研究了10位急性心肌梗塞病人经長時間心肺復甦後的结果。心肺復甦術的時間由10分鍾至30分鍾不等。所有的病人其心電圖均顯示有急性心肌梗塞，其中前壁梗塞及下壁梗塞各有5人。肌磷肌激酵素的最高值分别由748至超過10000IU/L不等，梗塞血管的氣球擴張術全部成功。经氣球擴張術後，病人的冠状動脈血流完全暢通。10位病人當中有9位可以活著出院。施行冠状動脈氣球据擴張術過程中，並無嚴重併發症産生。因此，急性心肌梗塞病人接受长時間的心肺復甦術後，仍然可以接受直接冠状動脈氣球擴張術的治療。急性心肌梗塞病人封血栓溶解治療有禁忌的情形下，可以接受直接冠狀動脈氣球擴張術。

關鍵字

直接冠状動脈氣球擴張術 ； 心肌梗塞 ； 心跳停止 ； 心肺復甦術

並列摘要

To evaluate the safety and efficacy of primary percutaneous transluminal coronary angioplasty(PTCA) for acute myocardial infarction(AMI) complicated by out-of-hospital cardiac arrest, 10 patients with AMI following prolonged cardiopulmonary resuscitation(CPR) in a period of 5 years were studied. The CPR duration ranged from 10 to 30 minutes. Electrocardiographic evidence of AMI was documented in all patients, with 5 patients in anterior wall and 5 in inferior wall. Peak creatine kinase ranged from 748 to＞10,000 IU/L. Attempted infarct vessel angioplasty was successful in all patients. After angioplasty, the coronary flow was TIMI 3 in all patients. Nine patients survived to hospital discharge. No major complications were found during the angiolpasty procedure. In conclusion, it was feasible and safe to perform primary PTCA for AMI patients with prolonged CPR. Patients with contraindication to thrombolytic therapy may benefit from primary PTCA.

並列關鍵字

percutaneous transluminal coronary angioplasty(PTCA) ； acute myocardial infarction(AMI) ； cardiac arrest ； cardiopulmonary resuscitation (CPR)