不稳定型心绞痛对策—解痉抗凝防栓和血管再通(附冠状动脉造影50例)
江一清,刘朝中,王岩
摘要(Abstract)：
临床病理和实验研究证实CAS可致CATH—AMI,硝苯吡啶或硝酸甘油静滴可防止之,为探索早期防治AMI的新途径对UA90例用NTG和H连续静滴1～2周与35例用口服扩冠解痉药复方硝酸甘油片,硝苯吡啶等对照,心绞痛控制率94.5%:48.6%;治疗组TXB_2由438±179.4降为173±62.9pg/ml;血小板聚集堆由31.8%降为21.3%,p均<0.05;发展为AHI者2.2%(2/90):31.4%(11/35);p<0.01,病死率1.1%(1/90):8.6%(3/35).对UA 50例做CAG发现冠脉病变以左前降支最多见(90%),其次为右冠脉左旋支和左主干;70%为多支病变,76%为Ⅲ级以上严重病变,确诊AMI而冠脉无明显病变可能由CAS致AMI和UA占12%(6/50),治疗组8例UA多支严重狭窄者治疗后做CAG已有侧支循环形成,未发生AMI.10例进行PTCA,3例转外科做冠脉搭桥术均获冠脉再通.以上提示UA多在冠脉严重狭窄基础上由CAS诱发,及早扩冠解痉抗凝防栓治疗可防止、减少AMI和摔死,必要时予以血管再通术如PTCA,溶栓、冠脉搭 桥是UA严重发作时的重要对策.
关键词(KeyWords)： 冠脉痉挛(CAS);冠脉血栓形成(CATH);急性心肌梗塞(AMI);不稳定型心绞痛(UA);冠脉造影(CAG);硝酸甘油(NTG);肝素(H);PTCA
基金项目(Foundation):
作者(Author): 江一清,刘朝中,王岩
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