PCI术后再狭窄

【作者】 王杨春；

【导师】 戴万亨；

【作者基本信息】 成都中医药大学 ， 中西医结合临床， 2006， 硕士

【副题名】病理生理、诊断和中西医防治

【摘要】 PCI术后再狭窄(RS)是动脉壁对机械损伤的愈合反应，与PCI发展相伴相随。大量的研究证明RS形成与血栓形成、弹性回缩、动脉重构、新生内膜增生以及炎症有关，其中新生内膜增生是支架术后再狭窄的主要原因，而血管重塑是球囊血管成形术后再狭窄的主要原因。导致血管重塑和内膜增生的机制仍然尚未完全阐明。支架置入可以将再狭窄发生率从球囊血管成形术后30％～50％降低到10％～20％，因此针对内膜增生机制进行干预是目前防治再狭窄的关键。 近几年来，随着抗细胞增殖药物洗脱支架(DES)的发展，再狭窄的预防取得了突破性进展。最近的资料证明DES可再次将再狭窄发生率降低到0％～8％。 目前，中医认为RS与血瘀和痰浊有很大关系，在治疗方面积累了一定经验，并且研究中医药治疗RS作用机制的动物实验也有一定进展，显示中医药防治RS是安全而有效的。但缺乏多中心随机研究。更多还原

【Abstract】 Restenosis is the arterial wall’s healing respone to mechanical injury, which emerges with PCI. According to a large number of studies, restenosis is closely related with thrombosis, elastic recoil, vessel remodeling, neointimal hyperplasia, and inflammation, in witch neointimal hyperplasia is considered as the major reason of restenosis after stenting, and vessel remodeling for PTCA. But mechanism leading to neointimal hyperplasia and vessel remodeling is still remains unknown. Compared with balloon angioplasty, where the chance of restenosis is 30%～50%, stents have reduced the rate of restenosis within the stent to 10% ～ 20%. Once a role for stent implantation was established, the next goal was to overcome neointimal hyperplasia through pharmacologic and physical means.In the recent years, a breakthrough for the prevention of in-stent restenosis occurred in the form of drug-eluting-stents (DES) . Recent data demonstrated that patients treated with DES have a decrease in RS formation compared with those who received non-DES. With the use of drug-eluting-stents restenosis rates have decreased to 0%～8%.The basic pathogensis of Traditional Chinese Medirine(TCM) of RS is thought to strongly associate with Blood Stasis and Turbid Phlegm, some experience treating RS has been accumulated, and a lots animal experiments to find the antirestenotic mechanism of action of Chinese herbs have been developed, which show that the therapy of RS with TCM is safe and efficacious. But the randomized clinical trials testing the safety and antirestenosis effect of Chinese herbs are short.更多还原