【摘要】 目的　探讨低频高能超声溶解急性冠状动脉综合征(ACS)闭塞相关血管或“罪犯”血管血栓及粥样硬化斑块的有效性和安全性。　方法　ACS患者26例,其中ST段抬高急性心肌梗死19例,非ST段抬高心肌梗死3例,不稳定性心绞痛4例;左前降支闭塞 10 例,左冠状动脉闭塞 4 例,右冠状动脉闭塞5例。超声溶栓后对闭塞相关血管行急诊经皮冠状动脉腔内成形术。　结果　超声溶栓后,闭塞相关血管前向血流达心肌梗死溶栓试验3 级 19 例,开通 19 例,开通率为 73%(19/26),其中冠状动脉左前降支成功率最高。超声溶栓成功患者胸痛能完全缓解,心电图ST段下降50%以上,但术后残余狭窄平均为(73±11)%。急诊经皮冠状动脉腔内成形术后6例,残余狭窄降至(13±7)%(P<0. 05)。在超声溶栓中,7例出现并发症。　结论　低频高能超声可有效、安全溶解闭塞相关血管血栓,对富含血栓的病变可进行超声溶栓,可作为经皮冠状动脉腔内成形术的互补手段在临床应用。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of clinical application of coronary thrombolysis ultrasound (CTU) to the infarct-related artery (IRA) and criminal related vessels in acute coronary syndrome (ACS). Methods Consecutive patients (n=26) with acute myocardial infarction (AMI) (n=17) and non Q-wave MI (n=3) and unstable angina (UA) (n=6) underwent CTU. The occlusion of left anterior descending artery (LAD) occurred in 13 patients, LCX in 5, and RCA in 8. Thrombolysis in myocardial infarction (TIMI) grade 0 or 1 flow in the IRA was confirmed. Adjunct percutaneous transluminal coronary angioplasty (PTCA) after CTU was performed in all patients. Results Ultrasound induced successful reperfusion (SR) (TIMI grade 3 flow ) in 73% (19/26) of the patients and a residual stenosis of (73±11)%. SR occurred in 11 LAD segments, in 3 LCX segments, and in 5 RCA segments. PTCA was successful in all patients and a final residual stenosis of (13±7)% was determined by quantitative coronary angiographic analysis. During CTU, 7 patients had complications, but no severe complication and clinical side effects. Conclusions Coronary thrombolysis by ultrasound is a safe and effective modality in reperfusion therapy for vessels with thrombi. It can be combined with PTCA in selected patients.更多还原