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目的总结分析择期老年冠心病介入治疗连续病例的靶病变近端发生的急性医源性血管事件及其处理结果。方法对2001-2004年间完成的老年择期冠状动脉介入手术986例进行回顾分析,总结在处理靶血管中、远段靶病变的过程中,因为损伤近端非干预病变造成近端急性血管事件的发生率、特点和处理结果,比较发生和未发生急性血管事件的近端非干预病变的造影特点。主要分析指标包括病变成功率、靶病变近端急性血管事件率、并发症率和病死率。结果986例患者共干预2136根血管和2367个病变,植入2556枚支架。病变成功率100%,病例成功率99.9%,病死率0.1%,并发症率0.5%。2136支靶血管存在261处近端非干预性病变(12.2%)。发生近端急性血管事件24次,发生率9.2%,包括近端夹层11例(45.8%)、急性血栓形成5例(20.8%)、严重血管痉挛8例(33.3%)。近端非干预病变和近端急性事件病变造影特点无显著差异(P>0.05)。急性血管事件的处理结果为直接植入支架11例(45.8%),冠脉内溶栓后植入支架4例(16.7%),急诊静脉溶栓后植入支架1例(4.2%),冠脉内反复注射硝酸甘油缓解痉挛8例(33.3%)。结论(1)靶病变近端不稳定斑块的识别对介入操作的决策和步骤具有重要影响;(2)靶病变近端不稳定性斑块的机械性激惹和破坏是造成术中和术后近期急性血管事件的重要原因之一;(3)准确识别和有效保护靶病变近端不稳定斑块是防止围术期并发症的重要措施;(4)介入手术后加强稳定斑块的药物治疗具有重要意义。
Objective To summarize and analyze the acute iatrogenic vascular events that occur in the proximal end of the target lesion in consecutive patients with elective coronary intervention. Methods A retrospective analysis of 986 elderly patients undergoing elective coronary intervention from 2001 to 2004 was conducted to summarize the recent occurrence of proximal acute vascular events in the treatment of target lesions in target vessels in the distal and distal segments because of injury to proximal non-interventional lesions Rate, characteristics and treatment results, compared with the occurrence and non-occurrence of acute non-vascular lesions of proximal non-interventional angiography features. The main analysis indicators include the success rate of lesions, the incidence of proximal acute vascular events, complication rates and mortality. Results A total of 986 patients intervened 2136 vessels and 2,367 lesions and implanted 2556 stents. 100% success rate of lesions, case success rate of 99.9%, fatality rate of 0.1%, the complication rate of 0.5%. There were 261 proximal non-interventional lesions (12.2%) in 2136 target vessels. There were 24 proximal acute vascular events with a rate of 9.2%, including 11 cases of proximal dissection (45.8%), 5 cases of acute thrombosis (20.8%) and 8 cases of severe vasospasm (33.3%). There was no significant difference in the features of proximal non-interventional lesion and proximal acute lesion (P> 0.05). The results of the treatment of acute vascular events were direct stent implantation in 11 cases (45.8%), intracoronary thrombolysis stent implantation in 4 cases (16.7%), emergency intravenous thrombolysis stent implantation in 1 case (4.2%), Intravenous injection of nitroglycerin to relieve spasms in 8 cases (33.3%). Conclusion (1) The identification of proximal unstable plaques in target lesions has an important influence on the decision-making and procedure of interventional operation. (2) The mechanical irritation and destruction of proximal plaque of target lesion is the cause of intraoperative and surgical After recent acute vascular events one of the important reasons; (3) accurate identification and effective protection of proximal lesions of the target lesion is an important measure to prevent perioperative complications; (4) interventional surgery to enhance the stability of plaque drugs Treatment is of great importance.