6例PCI术后支架内血栓形成患者的原因分析及防治

The factors and preventive treatments of in-stent thrombosis post percutaneous coronary intervention

目的分析PCI术后支架内血栓形成的病理生理机制、影响因素及防治策略。方法回顾性分析2012年1-7月我院心内科冠心病住院患者行PCI术后6例发生支架内血栓的基础病史、好发部位及危险因素。结果2012年1～7月，我院心内科共完成PCI术570例，6例患者（男性5例，女性1例）术后发生急性支架内血栓2例，亚急性支架内血栓4例，发生率1．0％。6例患者根据临床特点均行冠脉造影术＋PCI术，其中1例术中发生低复流，冠脉内注人硝普钠、硝酸甘油、替罗非班，可见远段血栓影，予替罗非班强化治疗，出现心率、血压下降，予以临时起搏器治疗。术后6例患者均出现胸痛，除1例未予采集心电图外，其余5例心电图示相关血管支配的心肌sT段抬高。对临床高度疑诊患者均紧急行再次PCI术，其中4例造影证实支架内血栓（3例经血栓抽吸术后症状消失，TIMI达到3级，存活出院，1例因反复发生心力衰竭而最终死亡），余2例突发胸痛来不及行PCI术而死于心跳骤停。结论支架内血栓形成与患者临床特点、病变因素、支架因素、介人手术相关因素、药物因素相关，急诊介入手术是治疗支架内血栓的首选。

Objective To analyze the factors of in-stent thrombosis and to evaluate the efficacy of emergent percutaneous coronary intervention （PCI） for it. Methods Baseline and follow-up data of 570 patients who underwent PCI in our hospital from January to July 2012 were analyzed. Results 6 patients with coronary in-stent thrombosis were confirmed in 570 patients （1.0%）. The in-stent thrombosis occurred from 4 hours to 8 days post PCI. Among these 6 patients, 6 patients presented recurrent chest pain, 3 patients manifested AMI, 2 patients suffered from cardiac arrests and 1 patient manifested heart failure. 4 patients were confirmed by emergent PCI and 1 diagnosed by electrocardiogram. 6 patients except 2 death patients were treated with emergent PCI （3 patients survived and 1 patients died）. Conclusion The risk factors of in-stent thrombosis were clinical diseases, lesion type, intervention operating factors, stent and anticoagulant therapy. Emergent PCI arc the most effective methods for treating in-stent thrombosis.