中外健康文摘
中外健康文摘
중외건강문적
WORLD HEALTH DIGEST
2013年
14期
137-139
,共3页
目的探讨股∕动脉支架术后急性血栓形成的原因。方法分析2例股∕动脉支架术后反复形成血栓的病例的治疗过程和用药方法。结果病例1的血栓形成可能与：1.在原有血管内膜炎（本病例为血栓闭塞性脉管炎）的基础上，支架金属的刺激导致动脉炎症和痉挛增加(强化他汀类药物和解痉治疗更为重要)；2.可能存在阿斯匹林和氯吡格雷抵抗？加用替罗非班后三联抗血小板效果良好；3.较小的最终管腔内径（支架扩张不良或支架贴壁不良）；4.支架的支撑性和柔顺性：由于病变位于膝关节，选择支架时过多考虑支架的柔顺性，可能导致选择支架的支撑性降低，使支架的长轴变形，引起支架压缩。病例2的血栓形成可能与：1.病变段支架覆盖不全；2.较小的最终管腔内径；3.病人应用药物依从性差。结论病变段支架覆盖不全，支架金属的刺激导致动脉炎症和痉挛增加，阿斯匹林和氯吡格雷抵抗，较小的最终管腔内径（支架扩张不良或支架贴壁不良），选择支架时过多考虑支架的柔顺性，可能导致选择支架的支撑性降低，使支架的长轴变形，引起支架压缩，病人应用药物依从性差等因素可能导致股∕动脉支架术后急性血栓形成。
目的探討股∕動脈支架術後急性血栓形成的原因。方法分析2例股∕動脈支架術後反複形成血栓的病例的治療過程和用藥方法。結果病例1的血栓形成可能與：1.在原有血管內膜炎（本病例為血栓閉塞性脈管炎）的基礎上，支架金屬的刺激導緻動脈炎癥和痙攣增加(彊化他汀類藥物和解痙治療更為重要)；2.可能存在阿斯匹林和氯吡格雷牴抗？加用替囉非班後三聯抗血小闆效果良好；3.較小的最終管腔內徑（支架擴張不良或支架貼壁不良）；4.支架的支撐性和柔順性：由于病變位于膝關節，選擇支架時過多攷慮支架的柔順性，可能導緻選擇支架的支撐性降低，使支架的長軸變形，引起支架壓縮。病例2的血栓形成可能與：1.病變段支架覆蓋不全；2.較小的最終管腔內徑；3.病人應用藥物依從性差。結論病變段支架覆蓋不全，支架金屬的刺激導緻動脈炎癥和痙攣增加，阿斯匹林和氯吡格雷牴抗，較小的最終管腔內徑（支架擴張不良或支架貼壁不良），選擇支架時過多攷慮支架的柔順性，可能導緻選擇支架的支撐性降低，使支架的長軸變形，引起支架壓縮，病人應用藥物依從性差等因素可能導緻股∕動脈支架術後急性血栓形成。
목적탐토고∕동맥지가술후급성혈전형성적원인。방법분석2례고∕동맥지가술후반복형성혈전적병례적치료과정화용약방법。결과병례1적혈전형성가능여：1.재원유혈관내막염（본병례위혈전폐새성맥관염）적기출상，지가금속적자격도치동맥염증화경련증가(강화타정류약물화해경치료경위중요)；2.가능존재아사필림화록필격뢰저항？가용체라비반후삼련항혈소판효과량호；3.교소적최종관강내경（지가확장불량혹지가첩벽불량）；4.지가적지탱성화유순성：유우병변위우슬관절，선택지가시과다고필지가적유순성，가능도치선택지가적지탱성강저，사지가적장축변형，인기지가압축。병례2적혈전형성가능여：1.병변단지가복개불전；2.교소적최종관강내경；3.병인응용약물의종성차。결론병변단지가복개불전，지가금속적자격도치동맥염증화경련증가，아사필림화록필격뢰저항，교소적최종관강내경（지가확장불량혹지가첩벽불량），선택지가시과다고필지가적유순성，가능도치선택지가적지탱성강저，사지가적장축변형，인기지가압축，병인응용약물의종성차등인소가능도치고∕동맥지가술후급성혈전형성。
Objective: Discuss the causes of the acute thrombosis after the femoral artery stent implantation. Method:Analysis the course of treatments and methods for the two cases of acute thrombosis after the femoral artery stent implantation. Results: The possible cause of thrombosis for the case 1 is: 1) On the basis of endoangiitis, the stimulation of metal stent placement causes the artery inflammation and the increasing spasm. (It’s more important to use the statin and spasmolysant treatment.) 2) There maybe has the resistance of aspirin and clopidogrel. It has much better effect after adding the tirofiban. 3) The inner diameter of blood vessel is too small (The stent wasn’t expandable very well or malapposition). 4) The tenability and flexibility of stent may influence the effects. Because the lesion is located at the knee joint, if we focus on the stent’s flexibility too much, it may lead to reduce the tenability, deform long axis of stent and finally compress the stent. The possible cause of thrombosis for the case 2 is: 1) The lesion area is not covered fully with stent. 2) The inner diameter of blood vessel is too small. 3) The patient has a poor compliance for the treatment. Conclusion: The reasons such as none covered wholly with stent in the lesion area, artery inflammation and spasm increasing resulted from stimulation of metal stent placement, the resistance of aspirin and clopidogrel, the smaller inner diameter, the deformation stent and unsatisfactory compliance with medication, may cause the acute thrombosis after the femoral artery stent implantation.
