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无现场心脏外科支持的经皮冠状动脉介入治疗

[Percutaneous coronary interventions without on-site cardiac surgical backup].

作者信息

Stajić Zoran, Mijailović Zdravko M

机构信息

Sala za kateterizaciju srca, Klinicko-bolnicki centar Zemun, Beograd, Srbija.

出版信息

Med Arh. 2009;63(3):166-70.

Abstract

Percutaneous coronary interventions are now, three decades after the first balloon angioplasty of the coronary arteries, safe, effective, and most commonly applied method of myocardial revascularization. The first percutaneous coronary intervention without "on-site" cardiac surgery began at the beginning of the nineties of the twentieth century, thanks to the improvement of techniques and materials used for these procedures, as well as the need to make available to citizens in remote areas modern and effective therapy. However, today, after nearly twenty years of application of percutaneous coronary interventions in facilities without cardiac surgery this issue remains controversial and unresolved. So despite the existence of a large number of interventional cardiology centers without "on-site" cardiac surgery in a large number of countries in which they performed a significant number of elective and primary interventions, the official guidelines of the associations for percutaneous coronary interventions still does not recommend implementation of interventions without the existence of "on -site" cardiac surgery. But, recently the focus shifts from the questions about presence of "on-site" cardiac surgery in the direction of defining criteria for performing percutaneous coronary interventions according to the highest standards regardless of the existence of "on-site" cardiac surgical backup. This review article gives the current view on current attitudes about the organization and implementation of percutaneous coronary interventions in facilities without cardiac surgical backup.

摘要

在首次进行冠状动脉球囊血管成形术三十年后,经皮冠状动脉介入治疗现已成为一种安全、有效的心肌血运重建方法,且应用最为广泛。由于此类手术所使用技术和材料的改进,以及为偏远地区居民提供现代有效治疗的需求,20世纪90年代初开始了首例无需“现场”心脏手术支持的经皮冠状动脉介入治疗。然而,时至今日,在无心脏手术支持的机构中应用经皮冠状动脉介入治疗近二十年后,这个问题仍然存在争议且未得到解决。所以,尽管在许多国家有大量无“现场”心脏手术支持的介入心脏病学中心,且这些中心开展了大量择期和急诊介入手术,但经皮冠状动脉介入治疗协会的官方指南仍不建议在没有“现场”心脏手术支持的情况下实施介入治疗。但是,最近关注点已从是否有“现场”心脏手术的问题,转向无论有无“现场”心脏手术支持,都按照最高标准定义经皮冠状动脉介入治疗的实施标准。这篇综述文章给出了当前对于在无心脏手术支持的机构中经皮冠状动脉介入治疗的组织和实施的态度的观点。

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