冠状动脉介入治疗并发冠状动脉穿孔及心脏压塞的处理对策

目的　探讨冠状动脉介入治疗 (PCI)中并发冠状动脉穿孔及心脏压塞的处理对策。方法　对我院 1989年 9月至 2 0 0 3年 9月期间发生的冠状动脉穿孔病例进行回顾性分析。结果　共完成经皮腔内冠状动脉成形术 (PTCA)及支架 72 32例。发生冠状动脉穿孔 18例 ,发生率为 0 2 5 % ,多数发生于慢性完全闭塞性病变 (83 3% ) ,其中引导钢丝所致穿孔者 9例 ,球囊扩张后穿孔 7例 ,置入支架后穿孔 2例。 14例 (77 8% )穿孔为少量对比剂排至心包腔内或心肌内 ,其中 7例用球囊长时间低压力贴附封堵破口 ,穿孔征象消失 ;6例用鱼精蛋白静脉注射中和肝素 ,1例未做特殊处理 ,穿孔消失。4 (2 2 2 % )例发生急性心脏压塞 ,超声心动图显示有心包积液 ,紧急心包穿刺引流后病情平稳。 2例外科急诊修补血管破口 ,同时行冠状动脉旁路移植术 (CABG)。无一例死亡。结论　PCI并发冠状动脉穿孔少见 ,及时发现和正确处理是避免严重并发症的关键。

Treatment strategy of coronary arterial perforation and cardiac tamponade compliating PCI

Objective To discuss the treatment strategy of coronary arterial perforation and cardiac tamponade in PCI Methods Patients with coronary arterial perforation in PCI were retrospectively analyzed Results PTCA and stents in 7?232 patients were performed There were 18 cases complicated with coronary arterial perforation, and the incidence was 0 25% The lesion for most patients was chronic total occlusion (83 3%) Nine cases were induced by guidewire Seven cases were induced by balloon inflation Two cases were induced by putting stent with high pressure inflation Small leakage of contrast medium into the pericardial space and cardic muscle was observed in 14 cases (77 8%) The perforation was closed by balloon inflation with low pressure for a long time in 7 cases and with protamine sulfate by intravenous injection in 6 cases ,there was no special treatment in 1 case Four cases (22 2%) complicated with acute cardiac tamponade with blood pressure decreased and became stabilization after pericardiocentesis Emergency coronary artery seal and CABG were performed in 2 cases There was no death Conclusion Coronary arterial perforation complicated by PCI is quite uncommon Timely diagnosis and correct treatment are very important