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背景:PTCA后急性冠脉闭塞(abrupt closure)的发生率为(?)%～8%,是影响PTCA疗效的主要早期并发症.可引起死亡,非致命性心肌梗塞,不少病人需重新行PTCA或急诊冠状动脉搭桥手术(CABG).目的:观察经皮冠状动脉成形术后与急性术后冠状动脉闭塞相关的血栓、止血因素.材料和方法:连续28例PTCA病人,男21例、女7例,年龄60±10岁.稳定性心绞痛6人,不稳定性心绞痛12人,心肌梗塞14人.另有15例冠状动脉造影病人作为本研究的对照.在常规抗栓基础上,所有PTCA病人术前3日开始口服抵克力得250mg,每日两次,术后持续4周.常规PTCA操作,支架置放由术者根据需要确定.所有病人于插入动脉鞘管和注射肝素前、术扣即刻、术后2h、24h外周静脉穿刺采血,酶联免疫双抗体夹心法测定血浆FPA(纤维蛋白肽A)和TM(血栓调节蛋白)抗原含量.结果:PTCA组扩张的冠脉在左前降支/左旋支/右冠状动脉分别为16支、5支和11支,有8例病人安放了支架.平均扩张次数4次,置管时间102±38min.术中肝素用量10500±2000U,术后用肝素时间1—25h.PTCA组病人(包括支架植入),术后FPA值明显下降,与术前值比较有显著性差异,维持至少24h.PTCA后即刻血浆TM显著性增加,持续2h以上,24h观察值恢复正常.冠造组术前后血浆两参数无显著性变化.PTCA组有3例术后出现胸闷不适,1例伴S
BACKGROUND: The incidence of acute coronary occlusion (?)% ~ 8% after PTCA is the major early complication of PTCA, which can cause death and non-fatal myocardial infarction. Many patients need to re-run PTCA or emergency CABG.Objective: To observe the thrombus and hemostasis factors of coronary artery occlusion after percutaneous transluminal coronary angioplasty.Materials and methods: A total of 28 PTCA patients, 21 males and females 7 cases, age 60 ± 10 years old, 6 patients with stable angina, 12 patients with unstable angina and 14 patients with myocardial infarction.Another 15 patients with coronary angiography served as control in this study.On the basis of conventional antithrombotic therapy, all PTCA The patient started oral administration of 250mg orally twice daily for 3 weeks before surgery and continued for 4 weeks after operation.Conventional PTCA operation and stent placement were determined according to the needs of the surgeon.All the patients before insertion of arterial sheath and injection of heparin, The plasma FPA (fibrinopeptide A) and TM (thrombomodulin) antigen content were measured immediately after surgery, 2h and 24h after operation, and the coronary artery in PTCA group Descending branch / left circumflex artery / right coronary artery were 16, 5 And 11, 8 patients were placed in the stent. The average number of dilatation 4 times, catheterization time 102 ± 38min. The amount of intraoperative heparin 10500 ± 2000U, after the use of heparin time 1-25h.PTCA group of patients (including stent implantation ), Postoperative FPA decreased significantly, compared with preoperative values were significantly different, maintained at least 24h.PTCA plasma immediately after TM significantly increased for more than 2h, 24h observation returned to normal.Ganostomy group before and after the two plasma There was no significant change in parameters.PTCA group had 3 cases of chest discomfort after operation, 1 case with S