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目的探讨药物洗脱支架植入术后血栓形成患者的临床特点和治疗方法。方法回顾性分析15例PCI治疗后发生ST的冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料,着重分析发生ST的临床特征、治疗方法及结果。结果药物洗脱支架植入术后发生急性ST5例,亚急性ST7例,晚期ST2例,迟发晚期ST1例。15例均有典型胸痛表现,13例心电图检查示缺血性改变及酶学增加,12例行冠状动脉造影证实发生ST。其中合并原发性高血压13例,高血脂11例,吸烟10例,糖尿病10例,肾功能衰竭5例,心力衰竭6例。15例患者有2例随访过程院外发生心源性猝死,13例心电图证实支架段血管支配区域心肌缺血加重或呈急性心肌梗死表现,1例使用主动脉内气囊反博支持3d后死亡。剩余12例心导管造影复查示支架内闭塞,7例紧急PCI治疗行球囊扩张后血栓消失,均为亚急性ST;2例急诊行冠状动脉血栓抽吸术并冠状动脉内使用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂,均为急性ST。3例再次支架植入后血管再通,均为晚期及迟发晚期ST。12例经再次介入治疗均成功。结论药物洗脱支架植入术后ST的发生与患者高龄、糖尿病、过早停用抗血小板药物、心功能不全、多支病变、前降支病变等有关,再次PCI治疗为首选治疗方法。
Objective To investigate the clinical features and treatment of patients after thrombosis after drug-eluting stent implantation. Methods The clinical data of 15 patients with coronary atherosclerotic heart disease (CHD) who developed ST after PCI were retrospectively analyzed. The clinical features, treatment methods and results of ST occurred were analyzed. Results There were acute ST5 cases, subacute ST7 cases, late ST2 cases and late late ST1 cases after drug-eluting stent implantation. Fifteen patients had typical chest pain. Thirteen ECGs showed ischemic changes and enzymology. Twelve patients underwent coronary angiography to confirm the occurrence of ST. Including 13 cases of essential hypertension, hyperlipidemia in 11 cases, 10 cases of smoking, diabetes 10 cases, 5 cases of renal failure, heart failure in 6 cases. Out of 15 patients, 2 patients were followed up with sudden cardiac out-of-hospital disease. Thirteen ECGs showed myocardial ischemic or acute myocardial infarction in the vessel-dominated region of stent. One patient died within 3 days after intra-aortic balloon catheterization. The remaining 12 cases of cardiac catheterization showed intra-stent occlusion, 7 cases of emergency PCI were disappeared after balloon dilatation, all were subacute ST; 2 cases underwent coronary thrombus aspiration and intracoronary platelet glycoprotein Ⅱb / Ⅲa receptor antagonist, are acute ST. 3 cases of recanalization after stent revascularization, both late and late late ST. All 12 cases were successfully treated again. Conclusion The occurrence of ST after drug-eluting stent implantation is associated with advanced age, diabetes, premature discontinuation of antiplatelet drugs, cardiac insufficiency, multi-vessel disease and anterior descending coronary artery disease, and PCI is the first choice of treatment.