中国血液净化

›› 2005, Vol. 4 ›› Issue (11): 588-591.

• 论著 • 上一篇    下一篇

球囊扩张及支架在慢性透析患者冠心病治疗中的应用及疗效分析

宋 岩1 李冀军1 黄党生2 沈 东2 张丽伟2 陈凤琨1 张壹言1 罗北捷2

  

  1. 100037 北京，中国人民解放军总医院第304临床部 1肾内科，2 心内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-11-12 发布日期:2005-11-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-11-12 Published:2005-11-12

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摘要： 目的 探讨球囊扩张(PTCA)及支架术治疗慢性透析患者冠心病的疗效、注意事项及冠状动脉病变特点。方法 回顾分析解放军总医院第304临床部肾内科5例球囊扩张(PTCA)及支架术治疗慢性透析合并冠心病患者的临床及冠状动脉资料，观察其冠状动脉病变情况、介入检查治疗的安全性和疗效、透析方法及造影剂对肾功能影响。结果 5例患者中有3例行PTCA+支架术，术后患者不稳定性心绞痛均缓解，2例随访5～28个月后再发心绞痛，1例随访已38个月未再发作心绞痛。1例仅行PTCA扩张术，术后2月复发心绞痛，8个月后发作急性心肌梗死。1例病变轻未治疗。1例术后第1天出现左心衰竭。术中选用低渗性非离子型造影剂，术前及术后当日行血液透析，术后透析用动脉鞘管做动脉端，未追加肝素，无渗血及透析器凝血。术后有2例尿量减少，1例出现尿量一过性减少。结论 慢性透析合并冠心病患者经皮球囊扩张及支架治疗效果明确、安全可行，减少了心血管事件的发生。慢性透析患者冠状动脉病变复杂，病变范围广，多支多处病变、长病变、开口及分叉部位发病率高，冠状动脉病变情况与肾功能不全及透析时间不平行。选择低渗性非离子型造影剂，术后适量补液，术前、术后透析可减少造影剂的肾损害。术后用动脉鞘管做动脉端透析安全可行，可不再加用肝素。

关键词: 血液透析, 冠心病, 经皮球囊扩张术(PTCA), 支架

Abstract: Objective To investigate curative effect and complications of PTCA and Stenting in the hemodialysis patients with coronary heart disease Methods Five hemodialysis patients were treated with PTCA and stenting, the curative effect and complications were observed, the influence of dialysis method and contrast medium on renal function was also observed. Results Three patients underwent PTCA and Stenting, then unstable angina relieved, Re-angina occurred in two patients during the follow-up period of 5-30months. One patient who only experienced PTCA suffered angina two months later. Acute left heart failure occured in one patient in the first day after operation. Non-ionic and low-osmolar contrast medium was used during coronary angiography .All patients received hemodialysis in one day before and after the day operation. Using artery sheath as the artery end, no supplemental heparin during hemodialysis, no bleeding and thrombling in dialyzer. Ex-acerbation of renal function was noted in one patient. Conclusion It is possible to perform coronary angiography, PTCA and stenting in hemodialysis patients successfully and safely. Using non-ionic and low-osmolar contrast medium, paying attention to the dosage of contrast medium and using intravenous hydration, hemodialysis after and before operation can reduce renal damaging of contrast medium effectively. After operation, it is safe to using artery sheath as the artery end during hemodialysis and without supplemental heparin.

Key words: Coronary heart disease, Percutaneous transluminal coronary angiopiasty（PTCA）, Stent

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