2025 年第 12 期 第 20 卷

急性心肌梗死合并心源性休克患者经皮冠状动脉介入治疗入路选择的研究进展

Research progress on the choice of percutaneous coronary intervention approach in patients with acute myocardial infarction complicated with cardiogenic shock

作者：马浩然1张新勇1张明辉1王雯玄1崔海东2陈海刚2

英文作者：Ma Haoran1 Zhang Xinyong1 Zhang Minghui1 Wang Wenxuan1 Cui Haidong2 Chen Haigang2

单位：1首都医科大学附属北京安贞医院冠心病中心急诊冠状动脉病区，北京100029；2新疆生产建设兵团第一师阿拉尔医院心内科，阿拉尔843300

英文单位：1Emergency Coronary Artery Ward of Coronary Heart Disease Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Cardiology Alar Hospital the First Division of Xinjiang Production and Construction Corps Alar 843300 China

关键词：急性心肌梗死；心源性休克；经皮冠状动脉介入；经股动脉入路；经桡动脉入路

英文关键词：Acutemyocardialinfarction;Cardiogenicshock;Percutaneouscoronaryintervention;Transfemoralapproach;Transradialapproach

• 摘要：

• 心源性休克是急性心肌梗死严重且致死率高的并发症，约5%～10%的急性心肌梗死患者会发展为心源性休克，死亡率高达40%～50%。及时有效的血运重建能够最大限度地挽救缺血心肌，恢复心脏泵功能，从而显著提高患者生存率。经皮冠状动脉介入是目前主要的血运重建方式。经皮冠状动脉介入手术中，血管入路的选择对患者预后及并发症发生率有重要影响。目前，桡动脉和股动脉是常用的介入通路，桡动脉入路在降低出血并发症方面具有显著优势，但股动脉入路在复杂操作和机械支持中仍有不可替代的作用。大多入路研究建议在情况允许的条件下优先选择桡动脉入路，在特定情况下选择股动脉入路，但针对心源性休克患者的最佳入路尚无定论。本文将围绕急性心肌梗死合并心源性休克患者经皮冠状动脉介入手术入路选择的相关研究和临床实践，进行简要综述。

• Cardiogenic shock is a serious and fatal complication of acute myocardial infarction. About 5%-10% of patients with acute myocardial infarction will develop cardiogenic shock, and the mortality rate is as high as 40%-50%. Timely and effective revascularization can maximize the rescue of ischemic myocardium, restore heart pump function, and significantly improve the survival rate of patients. Percutaneous coronary intervention is currently the main revascularization method. In percutaneous coronary intervention, the choice of vascular approach has an important impact on the prognosis of patients and the incidence of complications. At present, radial artery and femoral artery are commonly used interventional access. Radial artery approach has significant advantages in reducing bleeding complications, but femoral artery approach still plays an irreplaceable role in complex operations and mechanical support. Most access studies recommend that radial access should be preferred when conditions permit, and femoral access should be selected in certain circumstances, but the best access for patients with cardiogenic shock is still inconclusive. This article will briefly review the related research and clinical practice of the choice of percutaneous coronary intervention approach in patients with acute myocardial infarction complicated with cardiogenic shock.