终末期肾病合并冠心病患者冠状动脉病变的特征及介入治疗的疗效

目的探讨终末期肾病合并冠心病患者冠状动脉介入治疗可行性及疗效,分析冠状动脉血管病变特点。方法对26例同期住院行血液透析合并明确心肌缺血的患者,其中8例行冠状动脉介入检查、治疗;18例维持药物治疗。分析冠状动脉病变情况、介入检查治疗的安全性及疗效。结果8例接受冠脉检查患者中,6例患者17支冠状动脉存在明显狭窄34处。其中A型病变:0处;B型病变:1处;C型病变:13处。5例为3支血管多处病变,1例为2支血管多处病变。6例完成支架治疗,术后心绞痛明显缓解。其中1例仅行PTCA,术后8月原扩张血管再次狭窄,予支架治疗。1例术后出现急性左心衰。选用非离子型低渗造影剂,术前及术后行血液透析,有2例术后尿量减少,1例肾功能轻度恶化。随访4~48月,6例接受介入治疗患者中2例出现临床心绞痛发作,1例术后3月死于多脏器衰竭。未接受冠脉检查、治疗的18例中,17例存在临床心绞痛发作(95%);2例发生急性心肌梗死,3例死亡。结论终末期肾患者冠状动脉病变复杂,病变范围广,长病变、钙化、多支多处病变发病率高。冠脉病变与肾功能恶化及透析时间不平行。终末期肾病合并冠心病患者的心脏介入检查治疗疗效明确、安全可行,可明确冠状动脉情况,改善患者临床症状,但对死亡率无明显影响。

Characteristics of Coronary Lesions and Percutaneous Coronary Intervention in Patients with End Stage Renal Disease and Coronary Heart Disease

Objective To study the characteristics of coronary lesions and the possibility of percutaneous coronary intervention (PCI) in the patients with end stage renal disease and coronary heart disease. Methods We retrospectively analyzed the clinical data of 26 patients with end stage renal disease and unstable angina pectoris. Eight patients received coronary angiography, and six of them received PCI. The other 18 patients were only given medicine therapy. Results Thirty-four severe coronary stenoses were showed in 17 coronary arteries: 10 lesions were classified as type A, 11 lesions as type B and 13 lesions were type C. Three vessels with multiple lesions were found in five patients, and one patient was ill with multiply lesions in two vessels. Six patients accepted stents and were alleviated from angina attacks during the follow-up. One patient was attacked by AMI eight months after PTCA and accepted three stents. The procedures were successful, expect that acute heart failure happened in one patient and mild deterioration of renal function was noted in one patient. With 4-48months’ follow-up, angina pectoris recurred in two persons and one died three months later. Among those who did not received PCI, 17 were attacked with angina pectoris, and three died. Conclusion There are more long lesions, calcification and extensive tortuosities in the patients with end stage renal disease. The rate of multiple lesions is high with more vessels involved. Coronary lesions are not paralleled with renal function and the time of hemodialysis. For patients with end stage renal disease and clinical ischemic symptom, coronary angiography is necessary to identify the lesions and guide treatment. It is safe and possible to perform PCI to improve clinical symptom and decrease cardiac events, but has no influencing on mortality.