冠心病伴左室功能不全患者冠脉支架术后疗效观察One year clinical outcome following coronary artery stenting in patients with severe ischemic left ventricular dysfunction
张抒扬,黄超联,沈珠军,朱文玲
摘要(Abstract)：
目的 我们回顾性总结一组冠心病伴左室功能不全患者 (LVEF≤ 40 % ) ,冠脉置入支架后 ,观察左室功能改善情况。方法 冠心病患者 ,1周内急性心肌梗塞或左主干病变或有心源性休克者除外 ,所有病人择期住入心脏病房。术前经超声心动检查测定LVEF≤ 40 %者入选。结果 46名不稳定型心绞痛患者 ,男 33名 ,平均年龄 6 6± 12岁 ,术前 1周以上有近期心肌梗塞患者占 15 % ,有陈旧性心肌梗塞 (>3个月 )者占 37% ,术前 6 5 %患者曾有充血性心力衰竭的发生 ,糖尿病者占 2 8%。冠脉造影示单支病变者占 2 % ,双支病变 13% ,三支病变 85 %。术前基础的LVEF为 2 7 1± 9 2 % ,LAD病变 18% ,LCX 13% ,RCA 2 8% ,大隐静脉旁路占 42 %。术中所有患者接受肝素维持ACT≥ 30 0秒。术后Aspirin 32 5mgODTiclid 5 0 0mg/日持续一个月 ,高压下置入冠状动脉支架 (平均压 15 7± 3 6atm)。术中 2 0 %病人辅以IABP。手术成功定义为 (置入支架后 <30 %残余狭窄 ,无住院期死亡 ,无CABG、QMI、急或亚急性支架内血栓形成 )结果临床成功为 98%的患者 (n =45 )血管直径狭窄由 92± 13 5 %降为1 5± 6 8% (P <0 0 0 0 1)。 2例患者支架术后 30内死于AMI。其他 43名患者随访 6～ 2 7个月 (平均 15个月 )。按CanadianCardiovasculaSoci
关键词(KeyWords)： 冠状动脉支架;冠状动脉搭桥术;不稳定型心绞痛;左室功能不全
基金项目(Foundation):
作者(Author): 张抒扬,黄超联,沈珠军,朱文玲
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