1例初诊冠状动脉-肺动脉瘘的循证治疗  

Evidence-Based Clinical Treatment for a First-Diagnosed Patient with Coronary Artery-Pulmonary Artery Fistula

作　　者：侯勇[1] 王联发[1] 纪勤炯[1] 李华[1] 周文兵[1] 章帮助[1] 

机构地区：[1]解放军第105医院心内科,合肥230031

出　　处：《中国循证医学杂志》2013年第4期494-496,共3页Chinese Journal of Evidence-based Medicine

摘　　要：目的为1例初诊冠状动脉-肺动脉瘘患者循证制定治疗方案。方法针对初诊冠状动脉-肺动脉瘘患者是否需要进行介入手术治疗的问题,计算机检索美国国家指南交换中心、e Cochrane Library、PubMed和MEDLINE,检索时限均从1990～2011年,获取并评价相关的系统评价、随机对照试验、临床对照试验及诊疗指南等最佳证据,并用于临床治疗。结果共检出冠状动脉瘘治疗的临床指南1篇,不同相关问题的高质量证据文献3篇。结果显示经冠状动脉介入治疗是当前最佳治疗手段,根据所获证据和患者意愿,患者入院后即予完善相关检查,积极做好经冠状动脉介入手术前的准备。入院3天后选择性冠状动脉造影检查结果显示,患者右冠状动脉-肺动脉瘘及左冠状动脉回旋支多发左房微瘘,遂行右冠状动脉-肺动脉瘘经皮冠脉介入弹簧线圈栓塞术治疗,并获成功,术后口服拜阿司匹林肠溶片0.1 g/d抗血小板聚集治疗,预防血栓性疾病的发生。术中及术后5天住院观察均未出现相关并发症。结论对有症状的冠状动脉-肺动脉瘘患者进行介入手术治疗是安全、有效的。Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronaD artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was neces- sary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and as- sess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary ar- tery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary inter- vention was the best treatment currently. According to the obtained evidence and patient＇s willingness, the relevant exam- inations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery- pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula, After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications, Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery- pulmonary artery fistula.

关 键 词：冠状动脉瘘 经皮冠脉介入术 循证治疗 

分 类 号：R541.1[医药卫生—心血管疾病]