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目的 探讨低频高能超声溶解急性冠状动脉综合征(ACS)闭塞相关血管或“罪犯”血管血栓及粥样硬化斑块的有效性和安全性。 方法 ACS患者26例,其中ST段抬高急性心肌梗死19例,非ST段抬高心肌梗死3例,不稳定性心绞痛4例;左前降支闭塞 10 例,左冠状动脉闭塞 4 例,右冠状动脉闭塞5例。超声溶栓后对闭塞相关血管行急诊经皮冠状动脉腔内成形术。 结果 超声溶栓后,闭塞相关血管前向血流达心肌梗死溶栓试验3 级 19 例,开通 19 例,开通率为 73%(19/26),其中冠状动脉左前降支成功率最高。超声溶栓成功患者胸痛能完全缓解,心电图ST段下降50%以上,但术后残余狭窄平均为(73±11)%。急诊经皮冠状动脉腔内成形术后6例,残余狭窄降至(13±7)%(P<0. 05)。在超声溶栓中,7例出现并发症。 结论 低频高能超声可有效、安全溶解闭塞相关血管血栓,对富含血栓的病变可进行超声溶栓,可作为经皮冠状动脉腔内成形术的互补手段在临床应用。
Objective To investigate the effectiveness and safety of low-frequency high-energy ultrasound in dissolving vascular thrombosis and atherosclerotic plaque in patients with acute coronary syndrome (ACS) occlusion. Methods Twenty-six patients with ACS were enrolled. Among them, 19 were acute ST-segment elevation myocardial infarction, 3 were non-ST-segment elevation myocardial infarction, 4 were unstable angina, 10 were occluded left anterior descending artery, 4 were occluded left coronary artery, Artery occlusion in 5 cases. Percutaneous transluminal coronary angioplasty for occlusion-associated vessels after thrombolysis with ultrasound. Results After ultrasonic thrombolysis, occlusion-associated prevascular blood flow reached myocardial infarction grade 3 in 19 cases, 19 cases were opened, the opening rate was 73% (19/26), of which the highest success rate of left anterior descending coronary artery. Patients with successful thrombolysis could be completely relieved of chest pain, ST-segment electrocardiogram decreased more than 50%, but the average postoperative residual stenosis was (73 ± 11)%. In 6 cases after emergency percutaneous transluminal coronary angioplasty, the residual stenosis decreased to (13 ± 7)% (P <0.05). Thrombolysis in ultrasound, 7 cases of complications. Conclusion Low-frequency high-energy ultrasound can effectively and safely dissolve occlusion-related vascular thrombosis and can thrombolysis-thromboembolic lesions, which can be used as a complementary means of percutaneous transluminal coronary angioplasty.