心内科医生总结:心脏病支架有哪些风险?

2021-01-31 心关注 心关注

冠状动脉支架是冠心病治疗的重要方法,但是在心脏病患者之间常常可以听到心脏支架“手术有风险”或者“支架有副作用”的说法,更有患者因为过度担忧而拒绝接受必要的支架治疗。

冠状动脉支架是冠心病治疗的重要方法,但是在心脏病患者之间常常可以听到心脏支架“手术有风险”或者“支架有副作用”的说法,更有患者因为过度担忧而拒绝接受必要的支架治疗。

风险虽然存在,但并没有传言般“吓人”!本文总结了心脏病支架常见的4个风险以及发生的概率:

一、冠状动脉并发症

支架的植入在需要众多器械的帮助下于冠状动脉内进行多次操作,比如导丝和球囊通过狭窄病变,球囊和支架在狭窄处扩张塑性血管。由于发生狭窄的冠状动脉十分脆弱,这些机械操作有可能造成血管的损伤。比如:

1. 冠状动脉痉挛发生率为1.32%,血管壁夹层或撕裂的发生率为2.58%。

2. 冠状动脉发生慢血流甚至无复流现象的概率为1%-5%。

3. 冠状动脉撕裂甚至穿孔导致的血管内血液外流至心包(包裹于心脏表面的囊性组织,用于保护心脏)出现心包填塞,发生率<1%,需要特殊处理者,如心包穿刺引流或外科切开手术,发生率<0.05%。

二、手术相关并发症

冠脉支架植入过程中需要进行血管内器械运送、冠状动脉支架扩张等一系列复杂而精细的操作,这些操作无法在医生直视下进行,但精度都要达到“毫米级”,十分考验术者水平的高低。

1. 支架手术相关器械都要经细小的动脉血管才能运送至冠状动脉内,但在运送过程中导丝、导管、球囊、支架可能出现打折、打结、折断或脱载,发生率为0.32%。

2. 人体血动脉管情况复杂,可能出现狭窄、钙化甚至闭塞,个别患者会因为手术器械无法推送至病变处导致手术失败,必要时需急诊冠状动脉搭桥,发生率为1%-2%。

三、心脑血管意外事件

1. 心脏病支架植入术中出现恶性心律失常,比如室颤概率<0.4%,急性肺、心衰概率<0.1%。

2. 急性心肌梗死性急诊支架植入时发生心脏破裂的风险约为0.96%。

3. 脑血管事件,如脑出血或脑梗死发生率<0.07%。

四、术后并发症

1. 因为患者个体差异对抗栓药物不敏感导致冠状动脉急性血栓形成,发生率为0.38%;血管闭塞发生率为1.99%;导致严重心肌缺血、急性心肌梗死甚至威胁生命的概率约为0.17%。

2. 支架植入后,冠状动脉内皮细胞可能发生过度修复导致再狭窄,金属裸支架发生率为10%-40%,现在常用的药物支架为5%左右。

3. 支架植入后需要长期服用抗血小板药物,患者出现重要脏器(脑、消化道)出血发生率为3%-5%。

任何手术都存在“手术风险”,但是如果风险在可控范围之内,我们大可不必过度害怕甚至“讳疾忌医”。

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    2021-03-30 ms5000001054985728

    学习了

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    2021-02-01 言西早

    冠状动脉支架是冠心病治疗的重要方法。

    0

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    2021-02-01 carrotlyl

    涨知识

    0

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