早期支架血栓形成住院患者22例临床分析  

Clinical characteristic analysis of in-patients with acute or subacute coronary in-stents thrombosis

作　　者：张春晓[1] 张健[1] 齐向前[1] 

机构地区：[1]天津医科大学心血管病临床学院泰达国际心血管病医院内二科,天津300457

出　　处：《临床荟萃》2011年第16期1401-1403,共3页Clinical Focus

摘　　要：目的分析冠状动脉药物洗脱支架(DES)植入术后住院患者早期支架内血栓形成(stent thrombosis,ST)临床特点并探讨其原因。方法对6 036例经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的22例早期ST患者临床资料、冠状动脉造影结果以及围手术期抗血栓治疗等相关因素进行回顾性研究。结果 2005年1月至2011年3月,我院资料库登记成功实施PCI治疗的6 036例住院患者,术后发生急性ST 2例,亚急性ST 20例,院内早期ST发生率0.36%。ST时间相对集中于术后较早期,20例亚急性ST形成时间为1～7天,平均(3.6±1.5)天;ST后所有患者均出现典型的临床表现及心电图改变。其中多支病变20例,急性心肌梗死(AMI)11例,血栓形成于前降支13例,21例经冠状动脉造影证实ST,13例紧急PCI治疗行球囊扩张后血栓消失,5例再次支架植入后血管再通,患者发生心室颤动5例,低血压状态6例。行急诊PCI治疗,18例患者治愈存活出院,4例患者死亡(病死率18.2%)。结论 ST是介入术后严重的并发症,与患者临床病变特点、介入操作因素、支架本身、抗血小板治疗不充分等因素有关,多发生在AMI,合并心功能不全,多支血管病变、前降支病变等患者。支架内血栓一旦形成,再次介入治疗是有效的抢救手段。Objective To analyze the clinical characteristics of early thrombosis in coronary stents and to investigate the possible cause of stent thrombosis（ST）.Methods We reviewed 6 036 patients who underwent percutaneous coronary intervention（PCI） and early thrombosis in coronary stents happened in 22 in-patients.The clinical data and angiography results and anti-thrombus treatment about 22 patients were studied.Results Baseline and follow-up data of 6 036 patients who underwent stent implantaion in our institution between January 2005 and March 2011 were analyzed.There were 2 patients suffered from acute ST,20 patients suffered from sub-acute ST.20 patients subacute coronary in-stent thrombosis occurred from 1 to 7 days post PCI median（3.6±1.5） d.All 22 patients presented recurrent chest pain and change of elcctrocardiogram（ECG）.Multi-vessels involvement was detected in 20 patients,acute myocardial infarction（AMI） occurred in 11 patients,while target lesions of left anterior descending artery（LAD）were found in 13 patients.Emergent coronary angiography（CAG） evidenced thrombotic occlusion in 21 patients,13 patients treated immediately with percutaneous transluminal coronary angioplsty and intra-coroanry stenting in 5 patients.Ventricular fibrillation happened in 5 patients,hypotension developed in 6 patients.All 22 patients were treated with emergent PCI.18 patients survived and 4 patients died（mortality 18.2%）.Conclusion ST was a severe complication of PCI.The risks of developing ST were clinical diseases,lesion type,intervention operating factors,stent,noneffective anti-platelet treatment.ST was higher in patients with AMI,heart failure,muli-vessel disease,target lesion on LAD.PCI is the most effective method and should be carried out as early as possible in order to improve the outcome of ST.

关 键 词：冠状动脉疾病 血栓形成 药物洗脱支架 冠状血管造影术 

分 类 号：R364.15[医药卫生—病理学] R541.4[医药卫生—基础医学]