经皮冠状动脉腔内成形术合并冠状动脉夹层的早期预后  

EarlyoutcomeofcoronarydissectionsfolowingPTCA

作　　者：盖鲁粤[1,2] 黄大显[1,2] 

机构地区：[1]解放军总医院 [2]奥大利亚悉尼皇家阿尔弗雷德王

出　　处：《中华心血管病杂志》1996年第5期344-346,共3页Chinese Journal of Cardiology

摘　　要：冠状动脉夹层是冠状动脉腔内成形术（ＰＴＣＡ）后重要的并发症。Ｎｈｌｂｉ将夹层分成６个不同类型，我们设想，如果不同类型的夹层其临床预后亦不同，处理上可区别对待。为此，本组筛选１０５例ＰＴＣＡ患者在术后２４小时内复查了冠状动脉造影，其中包括Ｅ＋Ｃ夹层９例，Ｅ型１９例，Ｄ型１０例，Ｃ型１６例，Ｂ型１５例，Ａ型７例，无夹层２９例，比较了各类夹层ＰＴＣＡ结束时和冠状动脉造影复查时的狭窄程度，最小动脉内径，夹层长度，以及各类夹层的临床预后。结果表明：Ｅ＋Ｃ，Ｅ，Ｄ型夹层不稳定，残余狭窄在ＰＴＣＡ早期明显加重，急性闭塞，心肌缺血事件和临床干预率明显高于Ａ，Ｂ，Ｃ型夹层，因此处理比较积极。Ａ，Ｂ，Ｃ型夹层相对稳定，可采取保守治疗。无论有无夹层，ＰＴＣＡ术后早期都有不同程度的回弹。Background:CoronarydissectionisthemajorcompliationofPTCAwhichcouldpo-tentialyresultinabruptcoronaryclosure.Wehypothesizethatdiferenttypesofthedissectionscar-rydiferentclinicalprognosis.Method:Onehundredandfivepatientswhounderwentrelookcoro-naryangiogrpahywithin24hoursofPTCAwereselectedfrom2386casesofthePTCA.DissectionswereclassifiedbyNHLBIcriteria.Percentageofstenosis,minimalluminaldiameterandlengthofdissectionsattheendofPTCAwerecomparedwiththoseattherelookangiography.Patientsclinicalevents(abruptclosure,chestpainwithSTchanges,bypass,rePTCA,stentimplantation)wererecorded.Resutls:TheresultsshowedthatthetypeC+E,EandDdissectionscarryadverseout-comewithworseningofstenosisandminimalluminaldiameter,andincreasedrateofischemiceventsandclinicalinterventions.However,thetypeC,BandAdissectionswererelativelystable.Conclu-sion:ClinicalinterventionisseldomneccessaryfortypeA,BandCdissections.However,considera-tionforbypassoperationorstentingmustbegiventotypeC+E,EandDduetohighchanceofun-favourableoutcome.

关 键 词：血管成形术 冠状动脉 冠状动脉夹层 预后 

分 类 号：R543.305[医药卫生—心血管疾病] R654.2[医药卫生—内科学]