血管内超声指导下的急性下壁ST段抬高心肌梗死直接冠状动脉介入治疗一例
刘健,王昭,王伟民
摘要(Abstract)：
<正>患者男,51岁。主因"急性胸痛5 h"入院。患者于入院当日9:30活动时突然出现心前区剧烈疼痛,向双侧肩背部及左上肢放射,伴大汗,舌下含服硝酸甘油数片效果欠佳,持续时间超过30 min。14:30急诊心电图提示:Ⅱ、Ⅲ、aVF导联ST段抬高0.3~0.4 mV,Ⅰ、aVL、V1、V2导联ST段压低0.1~0.2 mV,T波倒置(图1),诊断为"冠状动脉粥样硬化性心脏病,急性下壁ST段抬高心肌梗死(STEMI)"。患者否认高血压、糖尿病病史,吸烟30年(40支/d)。父母均患高血压、冠心病。查体:心率88次/min,血压132/87 mm H(g1 mm Hg=0.133 kPa),心界不大,心律齐,各瓣膜区未闻及杂音,无心包摩擦音,肺部、腹部查体未见异常,双下肢无水肿。辅助检查:谷丙转氨酶27 U/L,谷草转氨酶83 U/L,肌酸酐82μmol/L,高密度脂蛋白胆固醇(HDL-C)1.04 mmol/L,低密度脂蛋白胆固醇(LDL-C)
关键词(KeyWords)： 血管内超声;急性心肌梗死;冠状动脉介入治疗
基金项目(Foundation):
作者(Author): 刘健,王昭,王伟民
参考文献(References)：
- [1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38:675-690.
- [2]Steg PG,James SK,Atar D,et al.ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J,2012,33:2569-2619.
- [3]替罗非班治疗冠状动脉粥样硬化性心脏病专家共识组.替罗非班在冠状动脉粥样硬化性心脏病治疗的中国专家共识.中华内科杂志,2013,52:434-439.
- [4]Kushner FG,Ascheim DD,O'Gara PT,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2013,61:e78-e140.
- [5]Vlaar PJ,Svilaas T,Vogelzang M,et al.A comparison of 2 thrombus aspiration devices with histopathological analysis of retrieved material in patients presenting with ST-segment elevation myocardial infarction.JACC Cardiovasc Interv,2008,1:258-264.
- [6]Pandian NG,Kreis A,Brockway B.Detection of intraarterial thrombus by intravascular high frequency two-dimensional ultrasound imaging in vitroand in vivo studies.Am J Cardiol,1990,65:1280-1283.
- [7]Siegel RJ,Ariani M,Fishbein MC,et al.Histopathologic validation of angioscopy and intravascular ultrasound.Circulation,1991,84:109-117.