【摘要】 目的分析冠状动脉旋磨术围术期并发症的发生和处置。方法连续入选2012年1月至2016年12月在北京医院心脏中心接受冠状动脉旋磨术的107例冠心病患者,总结冠状动脉旋磨术围术期并发症的发生率和处置情况。结果 (1)冠状动脉内旋磨患者术后的血清肌酸激酶同工酶(CK-MB)[4.1(2.4~14.1)U/L比1.5(1.0~2.1)U/L,P<0.001]和心肌肌钙蛋白Ⅰ(cTnⅠ)[0.28(0.11~1.11)ng/ml比0.01(0.01~0.02)ng/ml,P<0.001]水平较旋磨术前均有显著升高。(2)旋磨术的靶病变有104例(97.2%)为复杂病变(B2/C型病变)。(3)共21例(19.6%)患者发生了旋磨术围术期并发症,旋磨后出现冠状动脉慢血流5例(4.7%),冠状动脉痉挛1例(0.9%),冠状动脉夹层9例(8.4%),有6例(5.6%)患者出现了一过性严重心动过缓(其中仅1例植入临时起搏器),有2例(1.9%)患者发生了旋磨头嵌顿。有1例(0.9%)患者发生边支闭塞;2例(1.9%)患者发生血管并发症(1例股动脉穿刺处血肿、1例纵隔血肿),术后出现对比剂肾病1例(0.9%)。所有旋磨患者围术期并发症均被安全处置,所有接受旋磨术的患者即刻手术成功率为98.1%,无住院期间急性或亚急性支架内血栓形成、心源性死亡、紧急冠状动脉旁路移植术(CABG)等事件发生。结论冠状动脉旋磨术的并发症并不少见,但严重并发症少,总体安全性良好,即刻手术成功率高。更多还原

【Abstract】 Objective To analyze the peri-procedural complications of coronary rotational atherectomy. Methods A total of 107 consecutive patients with coronary artery disease received rotational atherectomy from January 2012 to December 2016 were enrolled retrospectively. The occurrence rate and the management of peri-procedural complications were summarized. Results(1) The serum level of CK-MB and cTnⅠ in patients who received rotational atherectomy were signifi cantly elevated compared with the level before the procedure,[4.1(2.4-14.1) U/L vs. 1.5(1.0-2.1) U/L, P<0.001]and[0.28(0.11-1.11) ng/ml vs. 0.01(0.01-0.02) ng/ml, P<0.001], respectively. Of the 107 target lesions, 104(97.2%) were classifi ed as type B2 or C lesions.(2) Peri-procedural complications of coronary rotational atherectomy occurred in 21 patients(19.6%). There were 5 cases(4.7%) of coronary slow fl ow, 1 case(0.9%) of severe coronary spasm, 9 cases(8.4%)of coronary dissection after rotational atherectomy and 1 case(0.9%) of side branch occlusion. Six patients(5.6%) had severe sinus bradycardia, but only 1 patient required temporary pacemaker. Burr entrapment happened in 2 patients(1.9%). Peripheral vascular complications occurred in 2 patients(1.9%) with 1 case of femoral artery hematoma at puncture site and the other 1 case of mediastinal hematoma. One patient(0.9%) developed contrast induced nephropathy after the procedure.(3) All the peri-procedural complicationsof rotational atherectomy were benign. The procedure instant success rate was 98.1%, with no acute or subacute stent thrombosis, cardiac death, emergent coronary artery bypass graft occurred during hospitalization. Conclusions The complications associated with coronary rotational atherectomy are not rare, but severe complications are not common. The procedure could be safely performed with a high instant success rate.更多还原