经皮冠状动脉介入治疗并发冠状动脉穿孔25例分析

目的 探讨经皮冠状动脉介入治疗（PCI）并发冠状动脉穿孔的处理策略。方法纳入2004年5月至2010年10月行PCI治疗并发冠状动脉穿孔的25例患者,对患者的临床资料进行回顾性分析,根据穿孔的影像特征进行Ellis分型,对各型冠状动脉穿孔的处理策略进行分析与总结。结果冠状动脉穿孔的发生率为0.82%（25/2036）,其中Ⅰ型穿孔13例（52%）,Ⅱ型穿孔3例（12%）,Ⅲ型穿孔9例（36%）,死亡2例（8%）。Ⅰ型穿孔患者采取严密观察,但未行特殊处理。Ⅱ型穿孔患者予以停用抗凝药物,球囊长时间低压扩张,其中1例于术后24h出现心包填塞,心包穿刺引流后病情逐渐稳定。Ⅲ型穿孔患者4例经球囊低压力贴附封堵穿孔部位后破口消失,3例行带膜支架置入,2例在球囊长时间低压力贴附封堵穿孔部位同时使用鱼精蛋白,但使用鱼精蛋白后均出现冠状动脉内慢血流死亡;Ⅲ型穿孔患者中4例出现急性心包填塞。结论冠状动脉穿孔发生率低,但可导致严重临床后果,及时正确处理是减少恶性心脏事件的关键。

Percutaneous coronary intervention for treating complicated coronary perforation in 25 cases

Objective To discuss the treatment strategy for complicated coronary perforation with percutaneous coronary intervention(PCI).Methods The patients(n=25) with complicated coronary perforation treated with PCI were selected from May,2004 to Oct.2010.The clinical materials of all patients were analyzed retrospectively and given Ellis typing according to the characteristics of PCI images.The treatment strategy for different types of coronary perforation was summed up and analyzed.Results The occurrence rate of coronary perforation was 0.82%(25/2036),including 13 cases of type I coronary perforation(52%),3,type II(12%),and 9,type III(36%).There were 2 died cases(8%).The patients with type I coronary perforation were not given special treatment besides of careful observation.The patients with type II coronary perforation were not given anticoagulants anymore but given long and low-pressure balloon dilation.There was one case having cardiac tamponade 24 hours after the operation,and trended to stable after pericardial puncture drainage.In the patients with type III coronary perforation,the crevasses were disappeared in 4 cases after low-pressure balloon attaching and plugging on perforation parts,covered stents were implanted in 3 cases,and protamines were given to 2 cases at the same time of long and low-pressure balloon dilation but they died because slow coronary flow after protamines administration.Among patients with type III coronary perforation,there were 4 having acute cardiac tamponade.Conclusion The occurrence rate of coronary perforation is low,but it can cause serious consequences in clinic,so correct treatment is the key for reducing fatal cardiac events.