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目的:探讨药物洗脱支架(DES)置入术后严重冠状动脉(冠脉)痉挛的特点及预后。方法:回顾性分析2012例行冠脉药物支架置入术患者,随访1年,分析其严重冠脉痉挛的发生率、临床情况、冠脉造影和置入支架情况、痉挛发生时间、部位以及处理、预后。结果:DES置入术后1年内严重冠脉痉挛(冠脉直径狭窄≥95%)有28例(1.39%)。其中,急性冠脉综合征19例(67.8%)、多支血管病变20例(71.4%)、支架长度≤29mm25例(89.2%)。严重冠脉痉挛发生时间最常见在导管室和术后24h内,共18例(64.3%)、与术后1周内5例、术后4周内3例、术后1年内2例比较,差异均具有统计学意义(P<0.05)。严重冠脉痉挛最常发生部位为支架两端,共24例(85.7%),非靶血管严重痉挛病例4例(14.3%),差异具有统计学意义(P<0.01)。及时复查冠脉造影以及冠脉内注入血管扩张剂、必要时主动脉球囊反搏支持和支架置入是抢救的关键,一般预后较好。结论:DES置入术后严重冠脉痉挛并非罕见,其中在急性冠脉综合征、多支血管病变、支架长度≤29mm多见。严重冠脉痉挛最常发生在导管室和术后24h内的支架两端。
Objective: To investigate the characteristics and prognosis of severe coronary artery (spasm) after drug-eluting stent (DES) implantation. Methods: A retrospective analysis of 2012 cases of coronary stent implantation, followed up for 1 year, analysis of the incidence of severe coronary artery spasm, clinical conditions, coronary angiography and stent placement, spasm time, location and treatment Prognosis. Results: There were 28 cases (1.39%) of severe coronary artery spasm (coronary diameter stenosis≥95%) within one year after DES implantation. Among them, acute coronary syndrome in 19 cases (67.8%), multivessel disease in 20 cases (71.4%), stent length ≤ 29mm25 cases (89.2%). Severe coronary spasm occurred most commonly in the catheterization room and within 24h after surgery, a total of 18 cases (64.3%), 5 cases within 1 week after surgery, 3 cases within 4 weeks after operation, 2 cases within 1 year after operation, The differences were statistically significant (P <0.05). There were 24 cases (85.7%) in severe coronary artery spasm, and 4 cases (14.3%) in non-target serious vascular spasm. The difference was statistically significant (P <0.01). Timely review of coronary angiography and intracoronary injection of vasodilators, if necessary, aortic balloon pump support and stent placement is the key to the rescue, the general prognosis is good. Conclusion: Severe coronary spasm after DES implantation is not uncommon. In acute coronary syndromes, multivessel disease and stent length ≤29mm are more common. Severe coronary spasm occurs most commonly in the catheterization room and at both ends of the stent within 24 hours after surgery.