经皮冠状动脉介入术围术期严重出血诊治进展  

Treatment of Periprocedural Severe Bleeding in Percutaneous Coronary Intervention

作　　者：刘如[1] 袁晋青[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院心血管内科,北京100037

出　　处：《心血管病学进展》2015年第2期133-138,共6页Advances in Cardiovascular Diseases

基　　金："十二.五"国家科技支撑计划项目:冠心病抗血小板治疗的优选方案研究(2011BAI11B07)

摘　　要：出血是经皮冠状动脉介入术围术期的严重并发症之一,与不良临床预后显著相关。术前对急性冠状动脉综合征患者进行全面的出血风险评估十分必要,尤其是对消化道、颅内出血风险的评估。可应用2011年欧洲指南推荐的CRUSADE出血评分。对于出血中危及以上患者,应合理优化抗血小板和抗凝药物的种类、剂量和疗程。同时,桡动脉路径能减少出血和血管并发症,股动脉路径使用血管缝合装置亦可以降低穿刺点出血风险。鉴于消化道出血和颅内出血的特殊性,应根据专科指南结合心血管风险予以处理。Periprocedural bleeding has been always the severe implication of percutaneous coronary intervention（ PCI）,which is significantly associated with poor clinical prognosis both in short- and long-term of acute coronary syndrome（ ACS） patients. Thus,it is necessary to make comprehensive assessment of bleeding risk before PCI,especially for the risk of gastrointestinal bleeding and intracranial hemorrhage. The CRUSADE score system is recommended by the 2011 ESC NSTE-ACS guideline to access long-term prognosis and bleeding risk.For those patients considered as middle or high bleeding risk,antithrombotic drug therapy should be optimized. Furthermore,transradial approach to PCI may permit greater reductions in bleeding risk and vascular implications. The utility of vascular closure devices after transfemoral PCI may also bring fewer vascular access site bleeds. Considering the characteristics of gastrointestinal bleeding and intracranial hemorrhage,measures should be taken according to both speciality guidelines and cardiovascular risks.

关 键 词：出血 经皮冠状动脉介入术 避免出血风险的策略 

分 类 号：R541.4[医药卫生—心血管疾病] R815[医药卫生—内科学]