右冠脉急性闭塞时植入支架与择期支架疗效的对比研究

目的：分析右冠脉急性闭塞急诊冠状动脉造影时植入支架与择期支架的疗效．方法选择急诊入院右冠脉急性闭塞患者43名，分为试验组（急诊造影时植入支架）23例和对照组（急诊造影时择期支架）20例．观察研究2组的一般资料、冠脉病变、术前术后血栓、血流情况、残余狭窄和预后情况．结果2组病例的一般资料无明显差别；在冠脉近段、中段、远段病变分布情况中，试验组与对照组比较差异有统计学意义（P〈0.05）；在血栓和慢血流发生率上，试验组与对照组比较差异也有统计学意义（P〈0.05）．术后3个月复查造影和择期支架后，在病变部位残余狭窄率和慢血流上，试验组与对照组比较差异也有统计学意义（P〈0.05）；而在血栓和术后新发心血管事件上，2组比较无统计学差异（P〈0.05）．结论右冠脉急性闭塞时出现了血栓，如果血栓负荷不重，可以急诊造影后直接PCI；如果急诊造影后血栓负荷较重，可以行PTCA后择期行PCI．

Comparative Study on the Effect of Implanted Stent or Selected Operation in Patients with Acute Occlusion of Right Coronary Artery

Objective To study the effect of implanted stent or selected operation in patients with acute occlusion of right coronary artery during the emergency coronary arteriongraphy. Methods Forty-three patients with acute occlusion of right coronary artery who underwent the emergency coronary arteriongraphy were divided into two groups： the implanted stent group （ n = 23） during the emergency coronary arteriongraphy and the selected operation group （n =20） during the emergency coronary arteriongraphy . Then we observed the general data, the coronary artery pathological changes, preoperative and postoperative thrombus, the blood flow, remained stenosis and the prognosis. Results The implanted stent group was similar to the control group in general condition, but implanted stent group was significantly different from the control group in the near, intermediate and distal coronary artery pathological changes （ P〈0.05） . The control group was significantly different from the implanted stent group in the thrombus and slowly blood flow （ P〈0.05） . After three months, we reviewed coronary arteriongraphy and selected operation, The implanted stent group was significantly different from the control in the remained stenosis and slowly blood flow （P〈0.05） . But the implanted stent group was similar to the control groug in the thrombus and new proceeding cardiovascular events. Conclusion When thrombus appears in acute occlusion of right coronary artery, we can implant stent during the emergency coronary arteriongraphy if the thrombus is little, or we can select operation after PTCA on the contrary.