20例经皮冠状动脉腔内成形术

Percutaneous transluminal coronary angioplasty:report of 20 cases

目的：总结经皮冠状动脉腔内成形术（ＰＴＣＡ）的经验以求改善ＰＴＣＡ技术，提高临床ＰＴＣＡ的成功率。方法：ＰＴＣＡ按Ｇｒｕｎｔｚｉｇ方法进行。结果：对２０例严重冠状动脉硬化性心脏病患者进行ＰＴ－ＣＡ，共计３０支３９处血管病变中的２６支３５处病变进行了有效扩张，平均扩张次数３．５±２．６次／处，扩张时间６５±２１秒／次，扩张压力每次７．５±２．３ａｔｍ。平均狭窄程度由８７％减轻至１５％，狭窄完全消失的病变有２８处。１例术中发生急性冠状动脉闭塞，经植入支架后恢复正常，未发生其它严重并发症。总成功率１００％。术后心绞痛、心电图缺血性ＳＴＴ改变消失或减轻。结论：ＰＴＣＡ具有创伤小、疗效确切和较安全等优点；植入冠状动脉内支架是处理ＰＴＣＡ所致急性冠状动脉闭塞的有效方法；对于有指征的陈旧性心肌梗塞患者也宜积极采取ＰＴＣＡ的治疗，有助于提高生活质量。

Objective:To summarize the experience of percutaneous transluminal coronary angioplasty (PTCA) for improving the PTCA technique and increasing its rate of success.Methods:PTCA (Gruntzig method) was performed in 20 patients with severe coronary heart disease.Results:The procedure was done for 39 lesions of 30 diseased vessels.Among the 39 lesions,13 were of type A,and 26 type B and type C.Effective dilatation was performed in 26 to the 30 diseased vessels and 35 of the 39 lesions (type A lesions:13;type B and C:22).The average number of times of dilatation was 3.5±2.6, the average duration of dilatation was 65±21 seconds and the average dilatation pressure was 7 5±2 3atm.After PTCA,the average severity of the coronary artery stenosis decreased from 87% to 15%,the stenosis disappeared completely in 28 lesions.Coronary stent was implanted with the aim of treating acute coronary occlusion during PTCA in one patient,who recovered without other serious complication.The ischemic STT wave changes disappeared or were improved in all patients after PTCA.The overall rate of success was 100%.Conclusions:PTCA has the advantages of being not very invasive and comparatively safe,and having a definite therapeutic effectiveness,hence it can be used as an active treatment in old myocardial infarction when indicated.PTCA may help improve the patient's life quality and prognosis.