冠状动脉介入治疗中远段及分支冠状动脉穿孔的临床特点及预后  

Clinical Characteristics and Prognosis of Distal and Branch Coronary Artery Perforations during Percutaneous Coronary Intervention

作　　者：吴海云[1] 卓辉林[1] 戴若竹[1] WU Hai-yun;ZHUO Hui-lin;DAI Ruo-zhu(Quanzhou First Hospital Affiliated to Fujian Medical University,Fujian Quanzhou 360002)

机构地区：[1]福建医科大学附属泉州第一医院,福建泉州360002

出　　处：《深圳中西医结合杂志》2022年第23期12-15,共4页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:冠状动脉穿孔(CP)为冠状动脉介入治疗中罕见致命的并发症之一,总结福建医科大学附属泉州第一医院2012年1月至2020年1月期间32例经皮冠状动脉介入治疗(PCI)中冠状动脉远段及分支穿孔的临床特点、治疗及预后情况。方法:冠状动脉造影证实冠状动脉远段或者分支穿孔,记录分析患者年龄、性别、诊断、病变分型、穿孔的原因、穿孔的血管及部位、处理措施、术中及围手术期预后。结果:患者平均年龄为(65±11)岁,女性比例31.3%,不稳定型心绞痛53.1%,急性心肌梗死46.9%,美国心脏学会/美国心脏病协会(AHA/ACC)冠状动脉病变分型C型病变84.4%,慢性完全闭塞病变(CTO)的比率为46.9%。穿孔原因中普通工作导丝为50%,CTO导丝34.4%,旋磨导丝3.1%,顺应性球囊9.4%,支架球囊3.1%,穿孔病例中ELLis I型为9.4%,Ⅱ型为43.8%,Ⅲ型46.8%,59.4%患者穿孔通过密切观察、中和肝素、扩张球囊压迫等成功封堵穿孔,31.3%患者穿孔成功通过栓塞治疗封堵穿孔,9.4%患者穿孔需支架或者覆膜支架封堵冠状动脉破口,9.4%患者合并有心包填塞,66.6%心包填塞发生术后,围手术期的病死率为9.4%。结论:PCI远段及分支穿孔发生率低,其合并心包填塞,病亡率高,早认识、早发现,积极有效处理CP,必要时采取多种封堵策略是抢救成功的关键。Objective Coronary perforation(CP)is one of the rare and fatal complications in coronary interventional therapy.To summarize the clinical characteristics,treatment and prognosis of 32 cases of distal and branch perforation of coronary artery treated by percutaneous coronary intervention(PCI)in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2012 to January 2020.Methods Coronary angiography was used to confirm the distal or branch coronary artery perforation,and the patient’s age,gender,diagnosis,pathological classification,causes of perforation,perforated vessels and locations,management measures,and intraoperative and perioperative prognosis were recorded and analyzed.Results The mean age of patients was(65±11)years,the proportion of females was 31.3%,the proportion of patients with unstable angina was 53.1%,acute myocardial infarction was 46.9%,and the American Heart Association/American College of Cardiology(AHA/ACC)classification of coronary artery disease was 84.4%.The rate of chronic total occlusion(CTO)was 46.9%.Among the reasons for perforation,common working guide wire was 50%,CTO guide wire 34.4%,rotary grinding guide wire 3.1%,compliance balloon 9.4%,stent balloon 3.1%,in perforated cases,ELLis type I 9.4%,type II 43.8%,type III 46.8%.The perforation of 59.4%patients was successfully blocked by closely observation,neutralization of heparin,expansion of balloon compression,etc.;the perforation of 31.3%patients was successfully blocked by embolization;the perforation of 9.4%patients required stents or coated stents to seal the coronary artery rupture;9.4%patients were complicated with pericardial tamponade;and 66.6%had postoperative tamponade.The perioperative mortality rate was 9.4%.Conclusion The incidence of distal segment and branch perforation of PCI is low,it is complicated with pericardial tamponade,and the mortality is high.Early recognition,early detection,active and effective treatment of CP,and adopting various plugging strategies when necessary are the key to s

关 键 词：冠状动脉穿孔 经皮冠状动脉介入治疗 冠状动脉远段及分支穿孔 

分 类 号：R541.4[医药卫生—心血管疾病]