介入治疗非ST段抬高的急性冠状动脉综合征

The interventional treatment of non-ST-segment elevation acute coronary syndromes

目的 观察介入治疗非ST段抬高的急性冠状动脉综合征 (acutecoronarysyndromes ,ACS)的安全性及临床效果。方法 16 5例ACS患者 ,接受急诊介入治疗的 89例 ,经内科治疗病情改善后再介入治疗的 76例。所有“罪犯”病变均予治疗 ,其中 4 1例患者同时接受了“罪犯”与非“罪犯”病变血管的治疗。介入方法有经皮冠状动脉腔内成形术 (PTCA) +支架、直接植入支架及切割球囊扩张。结果 16 5处“罪犯”病变PTCA后植入支架 134枚 ,直接植入支架 4 8枚。术后残余狭窄均 <10 % ;前向血流达TIMI 3级 ;136例患者心绞痛消失 ,11例有不典型胸痛 ,2 4h后消失 ;术前仅有胸闷症状的 18例患者 ,术后 15例消失 ,3例减轻 ;无术中死亡及急诊冠状动脉旁路移植术 (CABG)病例。随访 139例患者 2～ 18个月 ,2 0例再发心绞痛 ,有 14例冠状动脉造影提示再狭窄 ,其中 11例再次行PTCA ,1例PTCA +支架 ,2例接受外科CABG ;无急性心肌梗死、猝死及心功能恶化发生。结论 在条件具备的介入中心 ,由经验丰富和技术娴熟的介入治疗医生施行或在其指导下 ,对非ST段抬高的ACS患者进行介入治疗是积极有效的治疗措施 ,近、远期临床效果较满意 。

Objective To observe the effectivity and security of the therapy of patients with non ST segment elevation acute coronary syndromes (ACS) Methods In 165 patients suffering from ACS in recent 1 5 years, 89 patiens were treated with emergency interventional procedure meanwhile 76 patients were treated after medical therapy All “culprit' lesions were treated “non culprit' lesions of 41patients were treated at the same time Results 134 stents were implanted after PTCA and 48 stents were implanted directly in 165 “culprit' lesions Angina symptom of 136 patients disappeared, untypical chest pain of eleven patients disappeared after twenty four hours The uncomfortable symptom disappeared in fifteen patients, and alleviated in three patients There were no death cases and patients who needed emergency CABG During follow up from two to eighteen months, twenty patients suffered from angina again, and fourteen patients had restenosis confirmed by coronary angiography Eleven of them accepted PTCA again, one case accepted PTCA and stenting, and two of them accepted CABG No patients suffered AMI, sudden death and aggravation of heart function Conclusion The interventional treatment of non ST segment elevation ACS is positive and effective in a conditioned interventional center We have had satisfied clinical results