急性冠脉综合征PCI术后近期再发胸痛原因分析

Analysis of causes of relapse chest pain in early stage after percutaneous coronary intervention for acute coronary syndrome

关键词:  急性冠脉综合征  支架植入术  胸痛

Key words:  acute coronary syndrome  introcoronary stent implantation  chest pain

摘要:

［目的］分析急性冠脉综合征患者行经皮冠状动脉介入治疗（PCI）术后近期再发胸痛的原因。［方法］ 回顾分析过去26个月内行PCI术的320 例冠状动脉疾病患者术后胸痛的情况，其中，男186 例，女134 例，平均年龄60.5 岁。围手术期口服氯吡格雷及阿斯匹林，低分子肝素皮下注射，硝酸酯扩冠，控制危险因素，调整生活方式。［结果］术后有41 例患者近期复发胸痛，胸痛发生率为12.8%（41/320），其中由亚急性血栓形成致胸痛再发1 例，由边支闭塞及远端栓塞致胸痛再发3 例，因非完全血运重建所致2 例，由慢血流、无复流及快速心律失所致4 例，由支架植入反应及精神因素所致25 例，由其他脏器致非心源性胸痛6 例。［结论］冠状动脉支架植入术后胸痛发生率高，原因复杂多样，应仔细辩别，识别危险程度，积极干预。

Abstract:

［Objective］ This is to explore the possible causes of relapse chest pain in the early stage after percutaneous coronary intervention (PCI) for patients with acute coronary syndrome. ［Methods］ Intracoronary stenting was performed in 320 indicated patients with coronary artery disease during the last 26 months, which included 186 males and 134 females with an average age of 60.5 years old. In pre and post interventional procedure, medical treatment of antiplatelet with aspirin and clopidogrel, anticoagulation with low-moleclar-weight heparin, dilating coronary, devalution of blood lipids, risk factors control were carried out in all patients and chest pain was recorded in all of them. ［Results］ Of the 320 patients who underwent successful intracoronary stent, 41 (12.8%) patients presented chest pain. The symptom was caused by myocardial ischemia in 10 patients who had stent thrombosis, slow flow, side branch occlusion, arrhythmia. Non myocardial ischemia chest pain occurred in 31 patients who had stent dilating, anxiety, esophagogastric trouble. ［Conclusion］ A high incidence of chest pain after intracoronary stent implantation was observed in those patients. The causes were complicated and they should be distinguished carefully. Their risk should be recognized and they should be treated actively. It is necessary to explain the causes to patients and their family members to help them to be free from anxiety.