中国血液净化

›› 2002, Vol. 1 ›› Issue (11): 10-13.

• 论著 • 上一篇    下一篇

血液透析患者与心脏介入性诊断治疗

吴 华 孙福成 毛永辉 杨继红 何 青 徐中武 钱贻简   

  1. 100730 北京，卫生部北京医院肾内科(吴 华，毛永辉，杨继红，徐中武)，心内科(孙福成，何 青，钱贻简)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2002-11-19 发布日期:2002-11-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2002-11-19 Published:2002-11-19

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摘要： 【摘要】目的 探讨尿毒症血液透析患者进行冠状动脉造影术及经皮冠状动脉腔内成形术（PTCA）及支架置入术（Stent）的可行性及近期疗效。方法 5例血液透析患者，频繁心绞痛发作，常规药物治疗效果不佳；在血液透析及水化治疗配合下，应用非离子型低渗造影剂（优维显）行冠状动脉造影术，继之3例患者行冠状动脉球囊扩张及支架置入术。结果 5例冠状动脉造影术患者，4例有显著冠状动脉狭窄，其中2例为单支血管病变，2例为多支血管病变；3例患者行PTCA，置放支架1～4个，术后心绞痛症状明显缓解，肾功能无进一步恶化倾向，随访11～24个月，无其它并发症。结论 在血液透析患者中进行心脏介入性诊断和治疗是可行的，安全的，可显著提高透析患者生存质量，降低心血管病因的死亡率。

关键词: 冠状动脉造影, 经皮冠状动脉腔内成形术(PTCA), 支架置入术, 血液透析, 尿毒症

Abstract: 【Abstract】Objective To probe the possibility of coronary revascularization in uremic patients on dialysis. Methods Five uremic patients, who had also unstable angina and failed to respond to routine medical therapy, were performed with coronary artery angiography, and three patients were treated successfully with percutaneous transluminal coronary angioplasty(PTCA) and stenting. In order to minimize the adverse effect on kidney due to angiography, non-ionic and low-osmolar contrast medium was used and the procedures of angiography and PTCA were performed seperately. Further protection of the renal function was effected by more frequent dialysis and increased fluid administration. Results Coronary stenoses were evidently showed in four patients on angiography. After PTCA and stenting, angina disappeared in the three patients and no deterioration of renal function was noted. They were free from angina attacks in a follow-up period of 11 to 24 months, although there was a transient episode of heart failure in a patient with diabetes. conclusion It is possible to perform coronary angiography, PTCA and stenting in uremic patients on hemodialysis successfully and safely, provided due attention was paid to the choice of contrast medium and protective measures for renal function.

Key words: Percutaneous translumind coronary angioplasty (PTCA), stenting(Stent), Hemodialysis, Uremia