PCI结合冠脉内溶栓治疗右冠状动脉急性闭塞13例

目的：总结右冠状动脉（RCA）内注射大剂量尿激酶结合球囊扩张挤压的方法处理13例RCA急性血栓性闭塞的临床资料，评价其效果和安全性。方法：回顾性分析18例急性下壁心肌梗死病人的临床资料，在RCA近、中段急性闭塞部位急诊植入18枚普通支架后，闭塞的血管完全开通。但是，其中13例病人出现血栓栓塞支架以远的RCA主干，单纯球囊低压扩张挤压（4～6atm）等机械方法不能粉碎血栓，开通血管，遂通过导管向RCA注射50万U尿激酶（20min），再用球囊扩张挤压血栓；如果血栓不能被溶解粉碎，再注射尿激酶50万U，重复球囊扩张挤压。结果：6例接受冠脉内注射尿激酶50万U，其他7例接受尿激酶100万U，RCA血流恢复TIMI3级，远端RCA主干未见栓塞征象。13例病人住院期间无出血等并发症，随访2～20（10±8）个月未见发作心脏事件。结论：尤其是在没有Angiojet流体溶血栓吸引术或血管远端保护装置情况下，冠脉内注射大剂量尿激酶结合球囊扩张挤压血栓，不失为一种解决急性血栓性病变的简便易行而安全的补救方法。

A clinical analysis of intracoronary delivery urokinasc combined with PTCA in 13 cases with abrupt right coronary thrombotic lesion

Objective： To study the clinical effect and safety of intracoronary delivery of urokinase combined with balloon compression in 13 cases with abrupt right coronary artery （RCA） thrombotic lesion. Methods： Retrospectively reviewed data of 18 consecutive patients undergoing RCA stenting because acute RCA thrombotic lesions, of 13 RCAs beyond the stents were still occluded by thrombus shed from the primary lesions; thrombus was not dissolved by balloon dilation and compression with low pressure （4-6 atm） simply. They were given urokinase 500 000 units through guiding catheter （20 min）, afterward combined balloon dilation and compression on the thrombus; if the thrombus were not dissolved, repeat administration of urokinase 500 000units and balloon dilation, compression. Results： Six patients were given urokinase 500 000units, other 7 patients given 1 000 000units, their RCA flow restored to TIMI 3. Embolism was not present in the distal main RCA by angiography. Bleeding and major cardiac event were not found in 13 patients during the hospital stay and the following-up 2-20 （10± 8） months. Conclusion： Intraeoronary delivery of urokinase combined with balloon dilation, compression is regarded as an alternative easy and safe rescue strategy for treatment of abrupt RCA thrombotic lesion, if not has Angiojet rheologie thrombectomy or distal embolic protection especially.