经皮冠状动脉介入治疗64例静脉桥血管病变的临床疗效  

Sixty-four cases of percutaneous coronary angioplasty on saphenous vein bypass grafts

作　　者：李志忠[1] Sidney L Juergens CP 朱小玲[1] 陶英[1] 刘彤[1] 王苏[1] 李勇[1] 

机构地区：[1]北京安贞医院心肺血管病医疗抢救中心,100029 [2]澳大利亚Liverpool医院心内科

出　　处：《中华心血管病杂志》2005年第3期221-223,共3页Chinese Journal of Cardiology

摘　　要：目的　评价静脉桥血管经皮冠状动脉介入治疗及支架治疗后的早期临床结果。方法对 64例 91处大隐静脉桥血管病变行介入治疗,将术中及住院期间的临床结果和术中应用的其他介入治疗辅助装置一并录入数据库并进行分析。结果　手术成功率 95. 3%;术中发生非Q波心肌梗死1例(1. 6% )。一过性无再流现象 4例(6. 3% ),其中 1例置入支架后无再流而出现室颤,经电除颤、心脏按压、气管插管及置入主动脉内气囊反搏装置后血流恢复正常。应用血管远端保护装置 7例(10. 9% ),X sizer取栓系统 4例;术中或术后应用血小板GPⅡb/Ⅲa受体拮抗剂 25例 (39. 1% )。住院期共发生非Q波心肌梗死 2例,主要心脏不良事件发生率为 3. 1%。结论　静脉桥血管的经皮冠状动脉介入加支架治疗的即刻成功率高,近期临床效果满意,中、远期结果有待进一步随访;血管远端保护装置和血小板受体拮抗剂的应用有可能改善预后。Objective To evaluate the early clinical result of percutaneous transluminal coronary intervention (PCI) and stenting on saphenous vein grafts. Methods Percutaneous intervention was performed in 91 saphenous vein grafts in 64 patients. The data of clinical results during operation and hospitalization and that of other interventional assisting device were recorded in database and were analyzed. Results The success rate of operation was 95.3%, non Q wave myocardial infarction occurred in 1 patient(1.6%) and temporary no reflow phenomenon occurred in 4 patients (6.3%) during operation. Reduced antegrade flow and ventricular fibrillation happened in 1 patient after stenting and normal antegrade flow obtained after cardiac compression and tracheal intubation and insertion of IABP. The distal protection devices were used in 7 patients (10.9%), X sizer extraction system in 4 patients. Platelet glycoproteinⅡb/Ⅲa receptor blockers were administered in 25 patients (35.9%). Non Q wave myocardial infarction occurred in two cases , the incidence of major adverse clinical event was 3.1% during the period of hospitalization.Conclusions The instant success rate of PTCA and stenting of saphenous vein bypass grafts is high and recent clinical result is promising, but the middle and long term results remain to be further followed. The use of distal embolic protection device and GPⅡb/Ⅲa receptor blockers may improve its prognosis.

关 键 词：静脉 血管病变 经皮冠状动脉介入治疗 非Q波心肌梗死 支架治疗 术中 临床疗效 远期 恢复 成功率 

分 类 号：R543[医药卫生—心血管疾病]