经皮冠状动脉介入治疗术后近期行永久起搏器治疗的安全性探讨

为探讨经皮冠状动脉介入治疗 (PCI)术后 7天～ 2个月内行起搏器安置术的可行性 ,选择 2 3例冠心病行经皮冠状动脉腔内成形术 (PTCA) +支架术后近期需行永久起搏器治疗的患者作为观察组 ,按距PCI术后时间长短、停用和不停用抗血小板药分成三个亚组 ,另选同期行单纯起搏器置入的患者 132例作为对照组 ,观察伤口渗血情况及短时间内停药对再狭窄影响。结果 :术前未停用抗血小板药术中、术后渗血严重 ,皮囊内血肿发生率 10 0 % ,术前停药的两组血肿发生率亦高 ,分别为 2 5 %和 9% ,总发生率 30 .4 % ,远高于对照组 5 .2 % (P <0 .0 1)。观察本组短时间停用抗血小板药无相关血管事件 ,再狭窄发生率 2 6 %。结论 :起搏器手术尽量推迟至PCI术后 1个月 ,至少 2周以上 ,术前停用抗血小板药 3～ 5天 ,笔者认为是安全的。

Feasibility of Pace-maker Implantation Soon After Percutaneous Coronary Intervention

To study the feasibility of pace-maker implantation within 7days to 2 months after percutaneous coronary intervention (PCI),23 PCI patients were chosen and divided into three groups according to period after PCI,anti-platelet drugs withdrawl or without drugs withdrawl. Haemorrhagia and the effect on re-stenosis after short-term drug wi thdrawl were observed. Results:Among the patients without anti-platelet drugs withdraw l , haemorrhagia occurred seriosely and haematoma of the pace-maker skin-sac prese nted in all the cases. Within the two groups in which anti-platelet drugs had been withdrawed before the implantation, the incidence rate was high too, 25% and 9% separately. The total incidence rate of haematoma was 30.4%,which was higher tha n those in control group(5.2%). In this study, short-term anti-platelet drugs withdrawl did not induce relative blood vessals events, while the incidence rate of re-stenosis was 26%. Conclusion:Pace-maker implantation should be carried out as far as 1 month after that of PCI(at least 2 weeks after PCI). It is safe to w ithdraw anti-platelet drugs 3 to 5 days before implantation of pace-maker.