自发性冠状动脉夹层临床特征分析及不同治疗方式的随访研究  

Clinical features of patients with spontaneous coronary artery dissection and follow-up for different treatments

作　　者：程铖[1] 徐日新[1] 张强 曹天庆 刘晓东[1] 谢勇[1] 梅宏斌[1] CHENG Cheng;XU Rixin;ZHANG Qiang;CAO Tianqing;LIU Xiaodong;XIE Yong;MEI Hongbin(Department of Cardiology,Subei People Hospital,Yangzhou 225001,China)

机构地区：[1]苏北人民医院,江苏扬州225001

出　　处：《实用医学杂志》2021年第3期348-352,共5页The Journal of Practical Medicine

基　　金：扬州市社会发展项目(编号:YZ2016076)。

摘　　要：目的探讨自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)临床特征、治疗方式及随访预后,为临床实践提供参考。方法选择经冠脉造影联合血管内超声检查明确诊断SCAD患者共16例,分析其冠脉造影分型、治疗及随访预后情况。结果SCAD患者以中青年女性多见,占75%(12/16),起病以急性冠脉综合征为主要表现。冠脉造影显示的18处夹层主要发生于前降支(8例,44.44%),分型以冠脉造影"鼠尾状"特征性改变的ⅡB型最为常见。16例患者中10例药物保守治疗,6例介入治疗,总体预后良好,随访治疗后6个月冠脉造影提示冠脉夹层自愈性高。结论缺乏冠心病危险因素的中青年女性出现急性冠脉综合征表现,要高度怀疑SCAD可能。介入医生应该熟悉SCAD的冠状动脉造影特征,并联合腔内影像学检查(IVUS或OCT)加以证实或排除。对于靶血管远端血流TIMI3级的SCAD一般采用药物保守治疗,Ⅳ型高危SCAD患者采取介入治疗,推荐单纯球囊扩张,恢复靶血管TIMI3级血流为治疗目标,支架植入不是优先的选择。Objective To explore the clinical features,treatment and follow-up of spontaneous coronary artery dissection(SCAD)and to provide reference for clinical practice.Methods We studied 16 patients with SCAD diagnosed through coronary angiography combined with intravenous ultrasonography,analyzed SCAD types of coronary angiography,the treatment and follow-up.Results SCAD was frequently seen in young and middleaged women,accounting for 75%(12/16),characterized by acute coronary syndrome.Eighteen dissections involved in coronary angiography mainly occurred in anterior descending branches(8 cases,44.44%).Ten patients received drug-therapy,and six interventional-therapy.Patients were followed up for at least 6 months,and the total prognosis was good.Coronary angiography showed coronary artery dissections were highly self-healing.Conclusion The possibility of SCAD should be taken into consideration in young and middle-aged women without risk factors of coronary heart disease,characterized by acute coronary syndrome.Interventionist should master image features of SCAD coronary angiography,and promptly use intraluminal imaging .

关 键 词：自发性冠状动脉夹层 临床特征 冠脉造影 血管内超声 治疗 随访研究 

分 类 号：R543.3[医药卫生—心血管疾病]