经皮冠状动脉介入治疗并发冠状动脉穿孔临床特点和处理  

Incidence,management,and outcomes of coronary artery perforation: a single center experience

作　　者：周国伟[1] 张国兵[1] 李为真[1] 王毅[1] 徐浩[1] 储光[1] 杨文艺[1] 张治[1] 温沁竹[1] 孙宝贵[1] 刘少稳[1] 

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080

出　　处：《中国介入心脏病学杂志》2015年第7期381-385,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中并发冠状动脉穿孔(coronary artery perforation,CAP)的原因、临床表现、处理策略和院内转归。方法对上海交通大学附属第一人民医院2003年1月至2007年12月发生CAP的病例资料进行回顾性分析。结果 3312例PCI患者中有26例(0.8%)患者共发生27处CAP,其中指引导管引起的穿孔2例,导丝导致的穿孔15例(16处),支架术后的穿孔9例。16处导丝导致的CAP中,慢性完全闭塞病变12处,急性或近期闭塞病变3处,非闭塞病变1处。导丝导致的4例心脏压塞均为迟发性,最长者距离手术结束时间为46 h。9例支架术后的穿孔中,4例发生心脏压塞。本组资料共有9例发生心脏压塞,均进行心包穿刺引流,6例内科保守治疗治愈,3例行外科急诊修补术并冠状动脉旁路移植术,其中2例术后死亡。结论 CAP是PCI少见的并发症,导丝引起的CAP可导致迟发性心脏压塞甚至死亡。支架术后穿孔绝大部分在PCI术中即可发现,置入覆膜支架可能为首选措施。及时发现和正确处理是降低CAP死亡率的关键。Objective To study the incidence, management and in-hospital outcome of patients with coronary artery perforation in a single center. Methods All patients who experienced coronary artery perforation from Jan, 2003 to Dec, 2007 at First People＇s Hospital Affiliated to Shanghai Jiaotong University had their charts and angiograms reviewed. Results 26 coronary artery perforations occurred in 3312 procedures to yield an incidence of 0. 79%. There were 2 coronary artery perforations caused by guiding catheter （GC）, 15 coronary artery perforations induced by gnidewire （GW） and 9 coronary artery perforations related to coronary stenting. 11 out of 15 （73.3%） GW-associated perforations founded in chronic total occlusion intervention and among those 11 cases, 4 cases developed delayed cardiac tamponade. The latest tamponade happened 46 hours after procedure. 8 out of 9 stem-related coronary artery perforations were seen in catheterization laboratory and 4 eases were implanted with covered stents. 9 cases developed tamponade and all of them underwent emergency perieardiocentesis. Three patients were treated with emergency coronary artery bypass grafting and 2 died after surgical intervention. The overall mortality of coronary artery perforation is 7. 7% （2/26） in this group. Conclusions Coronary artery perforation is a rare complication of PCI. Guidewire-induced perforations were not benign and may result in late tamponade or death. Stent-associated perforations almost seen in catheterization laboratory and may need to implant covered stents. The key point to reduce the mortality of coronary artery perforation rely on immediate diagnosis and appropriate management.

关 键 词：经皮冠状动脉介入治疗 冠状动脉穿孔 心脏压塞 

分 类 号：R541.4[医药卫生—心血管疾病]