冠状动脉内支架置入术的临床疗效及影响因素

目的探讨影响冠状动脉内支架置入术疗效的相关因素。方法对1995年3月～1998年5月间75例冠脉内支架患者进行回顾性分析，评价手术疗效及并发症，观察终点为心肌梗死或死亡。结果75例患者共置入支架95个，成功率为97．9％，术中支架脱落2例(占2．1％)，术后6h急性血栓性闭塞1例。随访(24．4±13．6)个月，再发心绞痛7例，冠脉造影证实5例再狭窄，2例支架部位闭塞，其中1例死于不可逆性心原性休克。结论冠脉内支架手术成功率高、再狭窄率低，冠脉病变的特点及是否进行了有效的抗凝、降脂治疗，是影响临床疗效的重要因素。

The clinical efficiencyand the influence factors on coronary stentign for coronary heart diseases

Objective To summarize the primary outcome of 75 cases coronry stenting, and to evaluate the clinical efficiency and influence factors. Methods Seventy-five patients who had coronary stenting procedure during March 1995 to May 1998 were clinically and angiographic followed up with the endpoints of myocardial infarction and/or cardiac death. Results Ninety-five coronary stents were implanted in 75 patients with a success rate of 97.9% and residual stenosis of(9.1±7.6)%. Two stents fell off(2.1%) during procedure due to severe calcification but successfully extracted. No acute coronary events occurred except 1 patient who had AMI due to acute thrombosis closure 6 hours after procedure and re-PTCA succssfully. Clinical symptoms disappeared or relieved obviously in 73 of 75(97.3%) patients. 7 patients(9.3%) suffered from angina including 3 cases with AMI in 24.4±13.6 months follow-up. Angiography of these 7 cases showed restenosis in stent site in 5 and occlusion in 2. All received re-PTCA successfully, but 1 died of cardiogenic shock later. Conclusion Coronary stenting has high success rate and low restenosis rate. The most important factors which influence the clinical effect of coronary stenting are the characteristics of coronary lesion, effective articoagulant and lipid lowering therapy.