冠心病心绞痛经皮冠状动脉介入治疗术的临床观察

Clinical observation of percutaneous coronary intervention on the patients with angina pectoris

目的观察稳定型心绞痛、急性冠脉综合征患者经皮冠状动脉介入治疗(PCI)临床疗效与发病时情况进行研究。方法收集该院2009年6月～2009年7月部分住院心绞痛患者共34例,根据以往胸痛特点分稳定型心绞痛、不稳定型心绞痛两组,分析患者不同年龄段病史特点,发病情况。相关实验室检查如肌钙蛋白cTnT等、胸片心电图特征及冠脉造影相关动脉狭窄程度、病变范围、支架置入的临床疗效与发病相关危险因素进行分析研究。结果 34例心绞痛患者以急性冠脉综合征(ACS)住院23例,其中14例发病至就诊时间小于12h予急诊CAG+PCI治疗,以往病史属稳定型心绞痛4例,不稳定型心绞痛占10例,经开通相关血管症状很快缓解,另20例非急诊PCI,1例因LAD开口及近段病变无合适导管予内科保守治疗缓解,8例为"三支"弥漫性病变不适合支架介入治疗建议转外科手术治疗,2例为心肌桥转院治疗。结论稳定型心绞痛、急性冠脉综合征,尤其后者是心内科常见急诊,有适应证者应尽早行CAG+PCI治疗,可及时开通相关血管,挽救濒死的心肌、改善预后,不稳定型心绞痛血脂、心肌酶学改变及高血压病史两组无明显差异,但血糖及纤维蛋白增高明显高于稳定型心绞痛组。

Aim To observe the efficacy of PCI（percutaneous coronary intervention） in patients with stable angina pectoris or acute coronary syndrome according to the disease process.Methods 34 inpatients with angina pectoris were collected from June to July in 2009 and divided into two groups,stable angina and unstable angina,by chest pain.The characteristics of the patients,their medical history,age and the attacking situation were analyzed.The efficacy of the stent,and disease related risk factors were compared between the two groups,as well as the relevant laboratory examinations,such as troponin T（cTnT）,Chest X-ray,ECG,the stenosis and extent of the lesion of related arteries tested by CAG.Results Among the 34 patients,23 patients were hospitalized as acute coronary syndrome（ACS） and 14 patients（4 patients with stable angina and 10 patients with unstable angina） were for hospital in emergency during 12 hours given the treatment of CAG and PCI.The other 20 patients were treated with non-emergency PCI.One case was relieved by giving conservative medical treatment for the opening and proximal part of LAD without suitable catheter.8 patients,with three diffuse diseased arteries and without any indication for stent interventional treatment,were transferred for surgery.2 patients with myocardial bridge were transferred to another hospital.Conclusion Acute coronary syndrome is the most common emergency case in the cardiovascular department,as well as stable angina.The patients with those indications should be cured with CAG and PCI as soon as possible to rehabilitate the myocardial necrosis and improve the prognosis.The increase of blood-sugar and fibrin in unstable angina group is significantly higher than stable angina group.But there is no significant difference in blood-lipid,creatase and development of hypertensive disease between two groups.