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目的 观察 6 8例不稳定心绞痛 ,在内科药物治疗 2 4～ 4 8h基础上行介入治疗的近期临床效果。方法 全部病例入院后常规予抗血小板 (阿司匹林、噻氯匹定或氯吡格雷 )及抗凝药物治疗 (普通肝素静脉滴注或低分子肝素皮下注射 ) 2 4～ 4 8h ,介入性检查当天噻氯匹定或氯吡格雷酌情增加剂量。介入性治疗后 ,继续使用肝素 5～ 7d(部分患者术后全身肝素化 1～ 2d) ,口服阿司匹林、噻氯匹定或氯吡格雷 1～ 2月 ,并酌情使用转换酶抑制剂、β受体阻滞剂及他丁类降脂药 ,出院后继续随诊。 结果 共计 96支病变血管 ,其中 76支病变血管即刻进入介入性处理 ,余病变血管择期处理。共置入支架 85枚 ,3例置入支架后出现血管夹层 ,再次置入支架后夹层消失。无血管急性闭塞和亚急性血栓形成 ,近期无急性心肌梗死及死亡病例。置入支架以AVE(medrtonic)、BX(cordis)支架为主。除 2例出现穿刺部位小血肿外 ,本组病例未出现严重并发症。结论在给予药物治疗的基础上 ,介入治疗可以明显改善患者症状 ,缩短住院时间 ,方法有效、安全。保证治疗成功的关键是术前有效地抗血栓治疗和术中对病变的良好判断及手术中器材的选择。治疗中球囊、支架直径和长度的选择及扩张的压力和时间 ,对预防血管急性闭塞、夹层至关重要 ;术中尽量减少
Objective To observe the short-term clinical effect of 68 cases of unstable angina pectoris treated with interventional therapy on the basis of medical treatment for 24-48 h. Methods All cases were routinely given anti-platelet (aspirin, ticlopidine or clopidogrel) and anticoagulant therapy (unfractionated heparin intravenous infusion or low molecular weight heparin subcutaneous injection) 24 to 48 hours after admission. The interventional day Clopidogrel or clopidogrel increase the dosage as appropriate. Interventional treatment, continue to use heparin 5 ~ 7d (some patients after systemic heparinization 1 ~ 2d), oral aspirin, ticlopidine or clopidogrel January to February, and as appropriate, the use of converting enzyme inhibitors, β Body blockers and statins lipid-lowering drugs, continue to follow-up after discharge. Results A total of 96 vascular lesions, including 76 vessels immediately into the involvement of vascular lesions, the etiology of vascular elective treatment. A total of 85 scaffolds were placed. Three cases of vascular dissection were inserted into the scaffold and the dissection disappeared after the stent was placed again. No acute vascular occlusion and subacute thrombosis, the recent absence of acute myocardial infarction and deaths. Into the stent to AVE (medrtonic), BX (cordis) stent-based. In addition to 2 cases of small puncture site hematoma, the group did not appear serious complications. Conclusion On the basis of drug treatment, interventional therapy can significantly improve the symptoms of patients and shorten the length of stay, the method is effective and safe. To ensure the success of the key to the success of preoperative anti-thrombotic therapy and intraoperative good judgment of lesions and surgical equipment selection. Treatment of balloon, stent diameter and length of the choice and expansion of pressure and time to prevent acute vascular occlusion, dissection is crucial; surgery to minimize