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目的:观察过去5年里应用常规冠心病介入诊疗法对冠心病的临床诊断价值和治疗效果。方法:总结2001年5月~2006年5月期间,339例因发生胸痛、胸闷,心电图ST改变,心绞痛,急性、亚急性、陈旧性心肌梗死等而入心内科的住院患者,用Judking法或经桡动脉通路行选择性冠状动脉造影或(和)PT-CA、支架植入术。结果:339例患者中145例冠状动脉造影正常,211例有不同程度的冠状动脉病变,共有412处狭窄,A、B、C型病变数分别是87、248和77处。211例有>75%的冠脉狭窄或完全闭塞,其中189例患者共植入不同型号的支架288枚,188例植入支架后冠脉血流达TIMIⅢ级,1例因急性再灌注心律失常室颤而死亡。其余随访时间1~60个月,2例因支架植入后6个月支架内再狭窄,再次植入药物支架;2例复查发现支架内再狭窄而行冠脉搭桥术;1例支架内再狭窄失访;有2例因再发急性心肌梗死死于院外。所有操作中发生假性股动脉瘤2例,股动静脉瘘2例,拔动脉鞘时迷走神经反射5例等并发症。结论:①现有资料表明选择性冠状动脉造影仍是目前诊断冠心病的最佳手段。②PTCA、支架植入术的介入疗法是心内科治疗冠心病的首选方法。③本研究B、C型病变占绝大部分且PTCA、支架植入术顺利,说明C型病变不仅是PTCA、支架植入的适应证,而且成功率较高、效果好、并发症少。④有症状的5例复诊冠状动脉造影,发现有支架内再狭窄,再狭窄发现率为2.7%。⑤随着手术操作技术的提高和介入例数的增加,与操作有关的并发症逐渐减少。
Objective: To observe the value of clinical diagnosis and treatment of coronary heart disease (CHD) by routine coronary intervention in the past five years. Methods: From May 2001 to May 2006, 339 inpatients admitted to the Department of Cardiology due to chest pain, chest distress, ST changes, angina pectoris, acute, subacute and old myocardial infarction were analyzed by Judking method or Coronary artery angiography or (and) PT-CA, stenting was performed via radial access. Results: Of the 339 patients, 145 had normal coronary arteries and 211 had varying degrees of coronary artery disease with a total of 412 stenosis. The number of A, B and C lesions was 87, 248 and 77, respectively. Of the 211 patients, there were> 75% coronary stenosis or complete occlusion. A total of 288 scaffolds were implanted in 189 patients, TIMI grade Ⅲ was obtained in 188 patients after stent implantation, and 1 patient suffered from acute reperfusion arrhythmia Ventricular fibrillation and death. The remaining patients were followed up for 1 to 60 months. Two of the patients were reinserted with stent after restenosis within 6 months after stent implantation. Two patients underwent repeat coronary artery bypass grafting after stent restenosis. Squamous lost; 2 patients died of recurrent acute myocardial infarction outside the hospital. In all cases, there were 2 cases of pseudoaneurysm, 2 cases of femoral arteriovenous fistula, 5 cases of vagal reflex when pulling the arterial sheath. Conclusion: ① The available data indicate that selective coronary angiography is still the best method to diagnose coronary heart disease. ② PTCA, stent implantation interventional cardiology is the preferred method of treatment of coronary heart disease. ③ The majority of B and C lesions in this study and PTCA and stenting were successful, which indicated that C-type lesions were not only indications for PTCA and stenting, but also had high success rate, good effect and few complications. ④ 5 cases of symptomatic coronary angiography referral, found to have stent restenosis, restenosis was found in 2.7%. ⑤ With the improvement of surgical techniques and the increase of interventional cases, the number of complications related to the operation decreased gradually.