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目的 探讨冠状动脉介入治疗 (PCI)中并发冠状动脉穿孔及心脏压塞的处理对策。方法 对我院 1989年 9月至 2 0 0 3年 9月期间发生的冠状动脉穿孔病例进行回顾性分析。结果 共完成经皮腔内冠状动脉成形术 (PTCA)及支架 72 32例。发生冠状动脉穿孔 18例 ,发生率为 0 2 5 % ,多数发生于慢性完全闭塞性病变 (83 3% ) ,其中引导钢丝所致穿孔者 9例 ,球囊扩张后穿孔 7例 ,置入支架后穿孔 2例。 14例 (77 8% )穿孔为少量对比剂排至心包腔内或心肌内 ,其中 7例用球囊长时间低压力贴附封堵破口 ,穿孔征象消失 ;6例用鱼精蛋白静脉注射中和肝素 ,1例未做特殊处理 ,穿孔消失。4 (2 2 2 % )例发生急性心脏压塞 ,超声心动图显示有心包积液 ,紧急心包穿刺引流后病情平稳。 2例外科急诊修补血管破口 ,同时行冠状动脉旁路移植术 (CABG)。无一例死亡。结论 PCI并发冠状动脉穿孔少见 ,及时发现和正确处理是避免严重并发症的关键。
Objective To investigate the treatment of coronary artery perforation and cardiac tamponade during percutaneous coronary intervention (PCI). Methods A retrospective analysis of coronary artery perforation cases occurred in our hospital from September 1989 to September 2003 was performed. Results Percutaneous transluminal coronary angioplasty (PTCA) and stent were completed in 7232 cases. Coronary perforation occurred in 18 cases, the incidence was 0.25%, the majority occurred in chronic total occlusive lesions (83 3%), including guided perforation caused by wire in 9 cases, perforation after balloon dilatation in 7 cases, stent placement Perforation in 2 cases. 14 cases (77.8%) perforation for a small amount of contrast agent row to the pericardial cavity or myocardium, of which 7 cases with a long time low pressure balloon occlusion plug, perforation signs disappear; 6 cases with protamine intravenous injection Neutralization of heparin, 1 case without special treatment, perforation disappeared. 4 (22.2%) cases of acute cardiac tamponade, echocardiography showed pericardial effusion, emergency pericardial drainage after a stable condition. Two patients were surgically repaired for vascular abruption and underwent coronary artery bypass grafting (CABG). No one died. Conclusions PCI complicated with perforation of coronary artery is rare, and timely detection and correct treatment are the keys to avoid serious complications.