【摘要】 目的 :探讨基层医院开展冠状动脉支架植入术治疗冠心病的成功经验。方法 :选择冠状动脉造影阳性的 33例患者 ,男 2 4例 ,女 9例 ,年龄 38～ 77岁 ,平均 6 2 3岁 ,全部病例术前均有心肌缺血及不同程度心绞痛。术前 33例冠状动脉造影显单支病变 2 0例 ,多支病变 13例 (其中 3支病变 3例 )。病变长度 1 2cm～ 3 8cm ,狭窄形态多表现为不规则、偏心性、部分有索条状钙化、血栓及溃疡形成。狭窄程度为 85 %～ 10 0 %。 3例急性心肌梗死患者急诊做冠状动脉造影都显示左前降支闭塞。植入支架前 1～ 2d患者口服抵克力得和阿司匹林联合抗凝 ,术中肝素化 ,按PTCA和支架手术程序进行操作。结果 :33例 37支冠状动脉病变植入 4 9只支架 ,其中植入左前降支 2 1只 ,右冠状动脉 4只 ,左回旋支 12只。 33例全部一次植入成功 ,支架植入后经冠状动脉造影证实狭窄消失 ,效果良好 ,其中 3例急性心肌梗死急诊植入支架后 ,病情转危为安。结论 :冠状动脉内支架植入术是治疗冠心病的一种效果良好的介入性治疗技术 ,在基层医院也能安全地开展更多还原

【Abstract】 Objective: To discuss the experience of implantation of coronary atery stents to treat CHD in grass-roots hospital. Methods: 33 patients, including 24 male and 9 femal, 38～77 years old(average 62.3 years old), all had myocardial ischemia and different level of angina before operation. Preoperative coronary ateriography showed single branch lesion in 20 cases and multi-branch lesion 13 cases (tri-branch lesion among 3 of them). The length of lesion ranged from 1.2cm to 3.8cm, and the most constriction forms were anomalous, eccentric, cordlike calcification partly, thrombosis and ulcer. The degree of the constriction was from 85% to 100%. 3 emergency coronary arteriography with acute myocardial infarction manifested left anterior decending branch occlusion. The patients took ticlid (ticlopidine) and aspirin orally for anticoagulation 1～2 days preimplantation and heparinization during operation. Results: 33 cases with 37 branch lesions were implanted with 49 stents, including 21 left descending branches, 4 right coronary artery and 12 left coronary artery. Furthermore, all the operations were implantated successful without failure. Postimplantation coronary arteriography evidenced that the constriction had disappearred, especially in 3 AMI patients, the implantation eliminated the danger immediately. Conclusion: Coronary artery stents implantation is an effective intervene therapy for CHD and can be developed in grass-roots hospital safely.更多还原