Delaney A P, Lee R P, Kay S, Hansen P
Intensive Care Unit, Royal North Shore Hospital, Sydney, New South Wales.
Crit Care Resusc. 2003 Dec;5(4):258-65.
To assess the value of early invasive revascularization for the initial management of critically ill patients after acute myocardial infarction in the daily practice of a University-affiliated referral hospital and to gauge the impact of such a strategy on the intensive care unit.
A prospective observational study on all patients admitted to the Royal North Shore hospital who had acute pulmonary oedema and/or shock prior to acute angiography for acute myocardial infarction from January 1(st), 1998 to December 31, 2001.
During the study period 846 patients with acute myocardial infarction had coronary artery angiography, 139 had acute pulmonary oedema and/or shock prior to angiography. The average age was 70 years, 65% of whom were male. Approximately 70% of these patients were admitted to the intensive care unit and coronary artery bypass surgery was performed on 38%. Of those patients admitted to the intensive care unit, 95% required mechanical ventilation, 81% required inotropic support and 50% required intra-aortic Balloon counterpulsation. In-hospital mortality was 32%, 6 weeks mortality was 38% and 6 month mortality was 42%.
Our results confirm the benefit of early invasive revascularisation for critically ill patients after acute myocardial infarction although a substantial amount of intensive care unit resources and cardiothoracic surgical expertise were required.
评估在一所大学附属医院的日常医疗实践中，早期有创血管重建术对急性心肌梗死后危重症患者初始治疗的价值，并衡量该策略对重症监护病房的影响。
对1998年1月1日至2001年12月31日期间入住皇家北岸医院、在急性心肌梗死急性血管造影术前出现急性肺水肿和/或休克的所有患者进行一项前瞻性观察研究。
在研究期间，846例急性心肌梗死患者接受了冠状动脉造影，其中139例在血管造影术前出现急性肺水肿和/或休克。平均年龄为70岁，其中65%为男性。这些患者中约70%入住重症监护病房，38%接受了冠状动脉搭桥手术。在入住重症监护病房的患者中，95%需要机械通气，81%需要使用血管活性药物支持，50%需要主动脉内球囊反搏。住院死亡率为32%，6周死亡率为38%，6个月死亡率为42%。
我们的结果证实了早期有创血管重建术对急性心肌梗死后危重症患者的益处，尽管需要大量的重症监护病房资源和心胸外科专业知识。
