急性心肌梗死经皮冠状动脉介入术后支架内血栓形成临床研究  

Clinical study on stent thrombosis in acute myocardial infarction patients after percutaneous coronary intervention

作　　者：李爱焕[1] 薛莉[2] 

机构地区：[1]宁夏医科大学,银川市750004 [2]宁夏医科大学附属医院,银川市750004

出　　处：《临床合理用药杂志》2011年第8期7-8,共2页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的探讨急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)后支架内血栓形成(ST)的发生率、危险因素、治疗及预后。方法选择AMI行PCI治疗后发生ST的患者28例,围手术期均使用阿司匹林、硫酸氯吡格雷片或噻氯匹定双重标准抗血小板治疗和肝素抗凝治疗。结果因胃溃疡或出血未用或停用抗血小板药物后发生ST8例,在经球囊扩张(PTCA)并尿激酶溶栓术中发生室颤死亡1例,发生ST后急性左心功能衰竭死亡1例。22例均于PTCA或PCI治疗血管再通。2例经冠脉搭桥术(CABG)治疗好转。2例可能的ST在术后24h内出现心绞痛,心电图示ST段抬高,肌钙蛋白升高,经加强抗凝抗血小板治疗后病情好转。多因素logist回归显示前壁心肌梗死、心功能不全、C型病变、支架的长度及早期停用抗血小板药物是发病的危险因子(P<0.05)。结论 AMI患者PCI术后的ST形成发生率很低,但是预后较差。复杂的冠状动脉病变型类型和抗血小板治疗依从性差可能是ST形成的主要危险因素,积极早期介入治疗可改善预后。Objective To analyze the incidence rate,risk factor,treatment and prognosis of stent thrombosis（ST） in acute myocardial infarction（AMI） patients after percutaneous coronary intervention （PCI）.Methods 28 AMI cases who happened ST after PCI were chosen.All were given double standard antiplatelet treatment with aspirin,clopidogrel hydrogensulfate tablet or ticlopidine,as well as anticoagulant therapy with heparin.Results 8 cases happened ST because they didn′t use or stop using antiplatelet drugs because of gastric ulcer or bleeding.1 case died of ventricular fibrillation during PTCA and thrombolysis operation with urokinase.1 case died of acute left ventricular failure after ST.22 cases received revascularization after PTCA or PCI,and 2 cases improved after CABG.2 cases of impossible ST happened angina pectoris within 24 hours after operation,whose electrocardiogram showed that ST-segment raised and troponin increased,and they were improved after the antiplatelet treatment were stengthened.The multiple factor logistic indicated that anterior myocardial infarction,cardiac insufficiency,C type lesions,the length of stent and premature discontinuation of antiplatelet drugs were the risk factors（P0.05） .Conclusion The incidence rate of ST after PCI for AMI is low,but its prognosis is poor.Application of complex coronary artery lesions and discontinuation of antiplatelet drugs seem to be the major risk factors.The active early interention may improve the prognosis.

关 键 词：心肌梗死 急性 经皮冠状动脉介入 支架血栓 

分 类 号：R542.22[医药卫生—心血管疾病]