选择性冠状动脉造影及介入治疗术在儿童冠状动脉病变中的应用  

The application of selective coronary angiography and percutaneous coronary interventions in children

作　　者：张清友[1] 杜军保[1] 宋秀婷[1] 李万镇[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《发育医学电子杂志》2013年第2期91-96,共6页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的 探讨选择性冠状动脉造影术(SCAG)及介入治疗术(PCI)在儿童中的应用价值及其安全性、有效性.方法 对7例患儿进行了SCAG,并对其中2例进行了经皮冠状动脉成形术和支架植入术.患儿的年龄为1岁2个月～11岁,体重13～48 kg.5例具有川崎病病史,其中4例均有心肌梗死临床表现,1例为巨大冠状动脉瘤,其余2例临床上存在“心肌梗死”表现,但无川崎病病史.结果 5例具有川崎病病史患儿通过SCAG均有阳性发现,1例仅有冠状动脉瘤,临床上无心肌梗死表现的患儿通过SCAG也未发现冠状动脉严重狭窄和闭塞.其余4例临床上存在心肌梗死表现的患儿,在SCAG中均发现严重的冠状动脉狭窄或闭塞,其中2例为右冠状动脉完全闭塞；1例为左回旋支动脉瘤后狭窄达99％；1例为左冠状动脉主干末端狭窄达90％以上,前降支动脉开口处完全闭塞,左回旋支动脉开口处狭窄达80％～90％；2例临床上存在“心肌梗死”表现,但无川崎病病史的患儿,通过.SCAG也未发现冠状动脉异常.此外,还对2例经SCAG证实存在单支动脉严重狭窄和闭塞的青少年患儿进行了PCI,均给予经皮冠状动脉成形术加支架植入术.所有进行SCAG及PCI的患儿均获得了成功,无并发症发生.结论 SCAG和PCI在儿童中是安全、有效的.但其适应证尚需要进一步探讨,经验尚需进一步积累.Objectives Selective coronary angiography(SCAG)and percutaneous coronary interventions(PCI)are now commonly applied in adults with coronary artery disease.However the use of these methods is limited in children.Along with Kawasaki disease(KD)becoming the leading cause of acquired heart disease and increase of lipoprotein abnormalities and obesity in children,clinical coronary events more and more frequently occurred in childhood or very young adults.Thus,it is necessary to accumulate the experience of the use of SCAG and PCI in children.The present study aimed to assess the safety and the value of SCAG and PCI in children.Methods The SCAG was done on 7 children between 2001 to 2008.Among them,5 patients had a history of KD(4 with myocardial infraction,1 with giant coronary aneurysms),2 patients had clinical signs of 'myocardial infraction',but no history of KD.The age of the patients when SCAG was done was from 1 year 2 months to 11 years.Results Five patients with history of KD had positive results through SCAG.Four patients of them with clinical signs indicating myocardial infraction was found to have severe stenosis or occlusion in coronary artery,of whom 2 patients had complete occlusion in right coronary artery.One patient had99%stenosis in left circumflex.One patient had over 90%stenosis in distal left main trunk,complete occlusion in left anterior descending artery and 80%-90%stenosis in left circumflex.One patient with only giant aneurysm and without clinical signs of myocardial infraction was found to have aneurym in right coronary artery.Two patients with clinical signs indicating 'myocardial infraction',but without history of KD,were found no coronary artery disease.One patient with severe stenotic lesions in left circumflex and another patient with occlusion in right coronary artery were accepted percutaneous transluminal coronary balloon angioplasty and stent implantation.SCAG and PCI were successful and there was no complication in all patients.Conclusion SCAG and PCI are useful for assessing and ma

关 键 词：冠状动脉造影 冠状动脉介入治疗术 小儿 

分 类 号：R725.4[医药卫生—儿科]