急性心肌梗塞静脉溶栓后冠状动脉造影早期和晚期的改变

目的研究急性心肌梗塞（ALMI）静脉溶栓后冠状动脉的解剖特点及其演变。方法100例AMI病人应用尿激酶和链激酶溶栓后”分钟行早期的冠状动脉造影（CAG）。3～4周后再次行晚期的CAG。结果100例AMI溶栓成功60例，失败40例，再通率％％。CAG提示有残留血栓的84例（84％），其中有40例（48％）为冠状动脉完全阻塞。溶栓再通病人经3～4周后再次CAG发现，8例狭窄加重，10例狭窄减轻。结论AMI是由突然冠状动脉血栓性闭塞所致并可用溶栓剂或机械的方法使闭塞的冠状动脉再通。溶栓通常不能使血栓完全溶解，使用PTCA已被建议为改善严重残留狭窄病变的重要疗法。

Early and late coronary angiographic changes after thrombolysis in acute myocardial infarction

Objective To study early and late coronary angiographic changes after thromblysis in acute myocardial infarction. Methods Analysing early and late coronary an giograms of 100 patients with AMI who received urokinase or streptokinase for thrombolysis from March 1994 through June 1997. Among them, 82 were males and 18 females with age of 37 to 78 years and 60 patients were of anterior myocardial infarction and 40 inferior infarction. UK and SK infusion was at < 12 hour after the onset of the first symptoms and all the patients received CAG 60 to 90 minutes after transvenous thrombolysis. During angigraphy, classifying the grades of the infarct and perfusion of related artery according to flow of contrast medium (TIMI criteria). The classification of stenosis were decided by its severity and the condition of blood flow. To the grade 3 of arteral stenosis, if it could be reperfused thoroughly in time of less than 3 heart beats, it was classified as grade 2 flow (TIMI). Angiographic changes of coronary thrombs was observed at the same time. Result 60 patients were successfully reperfused and 40 failured. The ratio of reperfu sion was 60%. There was thrombus in 84 patientS (84%), and full coronary occlusion in 40 pa tientS (47% ) whose reperfusion were not successful and were of grade 4 to 5 stenosis, and they received immediate rescue After. After areA, 32 patients still have grade 0 to 1 stenosis, and in 8 patientS the PTCA were not successful because the guide wire could not pass through the stenosis or had heart failure during PTCA. Aopography was repeated after 3 to 4 weeks, in 60patients with successful reperfusion and in 8 patients whose immediate rescue PTCA were not successful and then became grade 4 to 5 of stenosis, and 10 pahents better 68 pahents were undergone selective PTCA and were successful. 64 patients were followed up fo rayeare, of whihc 16 patients had restenosis, 4 died of re-infarction. Conclusion AMI is caused by sudden coronaryocclusion of thrombus and can be reopened by using etnzyme or mechanical methods. There isresidual .thrombus 60 to 90 minutes following thrombolysis, and it will lyse continuously for a longtime during hospitalizahon, making the diseaseed artery better, but is also could be occlused again later in some cases. The process can be assessed was using CAG. The most of basicatherosclerohc stenosis is above grade 2 to 3. It indicated that thromblysis is not complete usually, and PTCA is only a complementary method to remove serious residual stenosis.