维普资讯 http://www.cqvip.com 解放军医学杂志 2 0 0 5年 7旦 笙 鲞 笙 !塑 ・ 论 著 : 垒 ・ !! ! 587 ・ ・ Cor onar y art ery t ri pl e ves s el l es i on:cl i ni cal anal ys i s of 68 c as es Ya ng Zhi hu i Qi u Ji a n Abs t r ac t Ob j ec t i ve To s t udy t he c l i ni c al c ha r act er s of c or onar y ar t er y t ipl r e ve ss el l e si on.a nd t o pr ovi de a t he or et i c al ba si s f 0r t he t her - a Dv t o t he di s eas e. Me t hods The cl i ni c al dat a of 68 ca se s of cor onar y ar ter y t ipl r e ves sel l es i on ( gr o up A)and 71 c ase s of or c on ar y a r t er y of s i ngl e or doubl e ves se l l e si on (gr o up B) wer e anal yz ed r et o spe r ct i vel y. Re s ul t s The r e l at d r e isk f act or s (hyper tensi on, hype rl i pi demi a,di abet e s and smoki ng)and t he cl ust er ing of t hes e f act or s we re not s i gni f i a nt c l y di f f er e nt be t wee n t he t wo gr oups(P> 0.05).W hi l e t he I X) s i t i ve r at e of t he exer c i se st r es s t es t e xi s t d r e e mar kabl e di f f er enc e bet we e n t he t wo gr oups(P< O.01).The ext r e me di f f e r ence s b et we e n t he t wo gr o ups ex ist d e al s o i n t he c ase s of bui l di ng ol c l at er al c i r c ul a t i on ( P< O.001),and i n LVEF and LVEDP (P< D 0.0001 )de monst r at d e by l e f t vent icul r ar angi ogmphy.The m aj or it y of t he or c onar y ar ter y l e si on i n gr oup A wa s on l evel I V,and muc h i l K) r e l e si ons of l e vel Ul and l evel I V occ ur r d e i n gr oup A t han i n gr oup 1 3 . Most pat i e nt s i n gr o up A ac cept d t e he or c on ar y i nt er ve nt i on, CD whi l e a f t er oper at i on t he a ngi na p ect or is emer ge d i n a hi gh r at e.t hen t he r ebui l di ng of or c o nar y c i r c ul a t i on had t o e done.C帅 dI b i 啊 The be st t r e at me nt f or t he pat i ent s wi t h c or on ar y ar te y t r ipl r e ve ss el l e si on s houl d b e t he op er at i on of c or on ar y ar ter y bypas s gr af t ( CABG)。i f i f s poss i bl e . Ke y wol ds c or on ar y di s eas e ;c or o nar y a ngi ogr aphy;t ipl r e ve ss el l es i on;ve nt r i c ul ar f unct i on,l ef t CLC Numh cr R654.33 D 冠状动脉三支病变 6 8例临床分析 摘 要 目的 邱 建 CD 羊志辉 分析冠状动脉三支病变的临床特点 , 为该类患者的治疗提供理论依据。方法 回顾性对 比分析经冠状动脉造影 明确为冠脉三支病变的患者 6 8例及冠脉单支或双支病变 7 1例的临床资料 。结果 三支病变组患者与单双支病变组四种高危 因素 ( 高血压 、 高血脂 、 糖尿病 、 吸烟 ) 及其聚集性未见显著性差异( P>O . 0 5) 。三支病变组运动平板试验的阳性率 ( 2 3 / 2 4) 显著高于单双支 病变组( 2 6 / 4 2, P<O . 0 1 ), 两组侧支循环建立情况及左室造影的 I VEF、 LVEDP值 比较均有显著性差异( P<O . 0 01 ), 三支病变组冠脉 发生率及需再次行血运重建 比例较高。结论 条件允许时 , 冠状动脉三支病变患者 目前应首选冠脉搭桥手术( CABG) 治疗 。 冠状动脉疾病 ; 冠状动脉造影术 ; 三支病变 ; 心室功能 , 左 中国图书资料分类号 CD 关键词 D 病变以 I V级为主 , 发生 Ⅲ级和Ⅳ级病变的处数较单双支病变组 显著增多 , 三支病变组 4 8 /6 8例 患者接受 了介入 治疗 , 但术后 心绞痛 R6 5 4 . 3 3 The pr e sent ar ti c l e cl i ni al c l y anal yz d 68 pat e i ent s whos e al l m,I V) ,and e ver y c ont i nuous st en os i s ves sel was na me d one l e si on. 1 ef t c i r cumf l e x or c on ar y ar ter y ,LCX;and f ight c or o nar y ar ter y, 1. 3 Ot her di agnos i s st andar d D i abe t es:Acc or di ng t o t he annual RCA ) had pat hol ogi al c l y change d , and c o mpar d t e hem wi t h di a gnost i c st anda rd of W H0 1 998。i f t he bl ood s ugar of empt y anot he r 71 c as es who suf f e r d si e ngl e or d oubl e m a i n c or on ar y s t om a ch ̄ 7.0mr nol /L and( or )t he s ympt om r andom bl ood s ugar D t hr e or c onar y ar ter ie s (1 e f t ant er ior des c endi ng c or o nar y , LAD; ≥ l1.1mmol /I or 2HPG≥ l1.1r r m ̄l /L i n O rr,t he pat i ent gui dance t o t he cl i ni cal do ct or s f or t he e p s at i ent s t r at e ment . s houl d b e di a gnos ed w it h t he di ab et e s[ . CD ar ter ies l es i on, s o t hat t he r es ul t s c an pr ov i de I l K) r e t he or et i c al 1 ai ni cal dat a Hyp er tensi on:Under t he o ndi c t i on of aki t ng no me di c i ne。t he bl ood pr es sur e t hat i s me a sur d e i n di f f er ent da ys r ac e he s an aver a ge 1.1 Pat i ent s Fr om June 1 998 t o June 2003。68 pat i e nt s( 58 me n val ue and r epea t s I l K) r e t han t i ce:s w yst ol i c pr es sur e≥ 1 40mmHg and 1 0 women,age d f o m r 43 t o 85,w it h an a ver a ge of 6 3)wer e and ( or )di as t ol i c pr es sur e≥ 90mmHgg . di agnos d e i n t he Gene r al Hospi t al of Gua ngz hou Mi l i t ary Ar a e as Hyper l i pi de mi a:To det er mi ne t he pat i ent s by a n y of t he or c on ar y ar te y t r ipl r e ve ss el l e si on (gr o up A ) by c or on ar y f ol l ow in g :s er um chol est er ol> 5.72mr nol /L。or se u m LDH > r i nt e v ent r i on. Thes e p at i ent s wer e c o mp ar d w e it h anot he r 71 3.64mmol /L。or s er um gl yc er i de> l_7mr n ol /L. pa t i ent s(53 me n and 18 women,age d f o m 35 t r o 77, w it h an Smoker:T o s moke 10 ci gar e t t es orI n or e e ver y day. aver a ge of 61 )di agnos e d by c or o na y r ar te y a r ngi ogr aphy as s i gl n e Exe r ci s e s t r es s t ext p o si t i ve: 1) Angi na pec t or is appear s or doubl em a i n or c on ar y ar te y l r e si on ( gr o upB) . 1.2 Di a gnos i s s t a ndar d f or c or o nar y ar t e y st r enos i s Le f t or ight f c or on ar y ar te y was r x-r aye d f o m r di f f er e nt bodyp os i t i ons a nd B1 孽呐 :Ya ng Zh i hui , MI V t, r e s e ar c h d i r e ct i on:b as i c a nd c l i n i c al researche s on angi ocar iopat d hy  ̄ t i o a:Na nf an g Me di c al Un iv e r s i t y (n ow wor ke d i n Me di c al di f f er ent di r e ct i ons by j udki ng' s c or onar y ar ter y a ngi ogr aphy,and Depar tment,Nati onal Un ivers i ty of D ef ense Te chnol ogy。Changs ha,Huna n t he s t e nos i s deg ̄ (< 25 , 26~ 5O ,51~ 75 , 76~ 1 00 )of 410073)(Yang Zh ihui );General Hospi tal of Guangzhou M i l i tary Command t he c ul pr it l e s i on wer e acc or di ngl y cl as s i f i d e i nt o f our gr a des( I, 1 I, ( Qi u J i a n) 维普资讯 http://www.cqvip.com ・ y 2 0 05 解放军医学杂志 2 005年 7月 第 3 o卷 筹 7期 Me l a — J Ch i n PLA Vol30 No 7 Jul 588 ・ — dur ing t he spor t mot i on; 2) ST s egme nt of l evel t ype or l a y- oron c ar y ar t er ies(LAD,LCX,RCA)mai nl y i n I V gr ade,whi l e obl i que t yp e s hi f t≥ 0.1 my dur in g or af t er t he s or p t,or a not her t he o mbi c at n i on it w h st e nos i s of l ef t a i m n t r unk ( LMT)wa s f ound 0.1mv de cl i ne f ol l owe d t he or i gi hal de cl i ned ST s e m ent;3)The g on l y i n 5 pat i e nt . s bl ood pr es sur e de cl i ne s a bout 10.31mm Hg dur i g n t he sp or t on t he basi s of t he bl ood pr es sur e bef or e t he spor t mot i or L 酬 1 .4 Obs er vat i on met hod and anal ysi s To a na l yz e t he di f f er e nces ves s el l esi on gr oup( The st e nos i gs de gre was al c cul at d e it w h e 2 The cl ass i f i at c i on of t he cul pr it l e si on i n t he t ipl r e of pat hogeni c f a ct or s ex i st e d b et ween t he t wo gr oups of c or on ar y t he most s e ver e l es i on) ar ter y di s eas e ( hy per tensi on, hyp er l i pi demi a, hyper gl yc emi a, t oba cc o us e).T o c ompar e t he t wo gr oups i n t he f ol l owi ng ways: t he expr ess i ons of t he c or on ar y ar ter y; t he f i is n he d exe r ci s d e s t r es s: t he bui l di ng of t he c ol l at er al c i rc ul a t i on, and t he l ef t ve nt r i c ul a r e j ct e i on f r ac t i on (LVEF) or l e f t vent ic r ul ar end- di as t ol i c pr es s ur e (LVEDP) by l ef t ve nt r i cul a r angi ogr aphy. T o anal yz e t he degr e of t he c or o nar y ar ter y s t enosi s i n t ipl r e ves se l t r at e ment or c or on ar y i nt er ve nt i on or CABG we r e f ol l ow-up 2.5 Qua nt i t y of st enos i s l e si on i n b ot h t ipl r e ve sse l gr oup and D t wo gr oups . And t he p at i ent s who ha ve ac c ept d me e di ci ne o nt c ol r gr o up(t o def i ne a c ont i nued s t e nos i s se ct i on as a l esi on): A t ot al of 295 l e si ons was o unt c e d i n t he 6 8 pat i e nt s of gr o up八 CD gr o up.T o c o mpar e t he numb er of t he ves se l l es i on be t we e n t he Among t hese l es i ons, 1 1 1 gr ade and I V gr ade l es i on wer e 36 sur ve ye d f or one ye ar . 1 .5 St at i s t i c s The c hi -s quar e t est was appl i d t e o c o mpa re t he cas es .The t -t est was e mpl oye d t o pr oces s t he dat a of o unt c i g. n ( 12.2%)and 202(6 8.5%),r es pe ct i ve l y.A t ot a1 of 130 1 e si ons was c o unt ed i n t he 71 pat i ent s of c ont ol r gr oup. Amon g t hes e l esi ons,U I gr ade and I V gr a de l e si on wer e 13(10 ) a n d 7 2 (55. 4 ),r es pec t i vel y.Ther e wer e l es s C is r es i n gr o up A t ha n i n gr o up B,but mor e c ase s w it h s er ious l es i ons i n t he f o1 T ne r t han i n 2 .1 The ver y danger o us f a ct or s:No s i gni f i cant di f f e re nce was t he l at t eL The r es 1 】 】 t s ar e s hown i n t abl e 3. D f ound b et we e n gr o up A a nd gr o up B i n hyper tensi on, hyper l i pi dem i a, hyp er gl yc emi a and sm o ki g, t n he i nci dence of 3 Qua nt i t y of s t e nosi s l es i on s i n ot b h gr oup A n d a gr oup B t he o nt c ol r gr o up.but have no s t at i s t i c al s i gn if i cant di f f er e nce ( P > O.05).The r e was no di s t i ngui s he d di f f er e nce on t he c l us t er in g l eve l of t he f our f act ors ment i one d ab o ve et b we e n t he t wo gr o ups. The r es ul t s ar e s hox vn i n Ta bl e 1. 2.2 CD hyper tensi on,hyp er l i pi dem i a n d s a moki ng was hi gher t han t hat i n Exer ci e s s t r es s t es t:Ther e we r e 24 c as es(p o si t i ve 23 A and B r epr esent group A and gr oup B,r espec ti vel y [ 9 5 . 8 ] )f i is n h d e e x e r c i s e s t r e s s t e s t i n t he t ipl r e ve s s e l l e s i o n D g oup r .Co mp a in r g w it h 4 2 c a s e s( os p i t i v e 26 E 61 .9 ])i n t h e o nt c ol r gr o up,P< O.O1 . CD 2.3 C ol l at er al ci r cul at i on and l ef t ve nt ic r ul ar f unc t i on:24 c ase s i n t he t ipl r e ve ss el l es i on gr oup (35.3 ) had bui l t c ol l at er a l ci r c ul at i on. I n t he c ont ol r gr oup,onl y 6 pat i e nt s(8.4 )di d t he s a l ue,P< 0.001 . The ve nt ic r ul ar a n gi ogr aphy: Ther e wer e 14 ca ses (20.6 )i n t he t ipl r e vess el gr oup,I N EF< 50 ,LVEF一 0.5522土 0.11 36 and LVEDP一 9.9706土 3.1857.研 l i l e i n c ont ol r LVEF一 0.6351土 0.11 19 and L 旺 ) P一 7.3944± 3.3954. No ( P< 0.001 ). e 1 C o mpar is o n on t he i nc i de nce a nd c l ust er i g n CD 酬 D s i gni f i a nt c di f f er ence ex is t d e i n o mpar c is on et b we e n t he t wo gr o ups l ev el of t he f our f ac t ors et b we e n t he t wo gr o ups . 2.6 The r es ul t s of t he t o w gr o ups ar e s ummar iz ed as f ol l ows:I n t he t r i p l e ves s el l es i on gr oup,28 p at i ent s(41.2 )suf f e r d f e om r myo car di u m i nf ar ct i on, 40 pa t i ent s (58.8 ) s uf f er d f e om r unst abl e n gi a a p n ct e or is,2 pat i e nt s a cc o mp an ie d wi t h hyper tr o phi c obs t r uc t i ve c ar di omyop at hy a n d 6 pat i e nts a cc o mpan ied t h vent r i cul ar n eur a ys m. I n t he c ont ol r gr oup,23 p at i e nt s( 32.4 ) s uf f e r d f e o m myo r c ar di um i nf ar c t i on, 15 pa t i ent s (21.1 ) s uf f er d f e o m unst r abl e a ngi a pe n ct or is, 33 pat i e nt s(46.5 ) s uf f e re d f r om st abl e angi a pe n ct or is .Bet we e n t he t wo gr o ups,t he i nc i de nce of myo car di um i nf ar c t i on di d not s how obvi ous di f f e re nc e (P> O.05),a nd t he i nci de nc e of t he uns t abl e t yp e angi a pe n ct or is s howe d a ver y r em a r kabl e di f f e r ence (P < 0.001) .I n a f ur ther a na l ys i s,t he f r equency of myo c ar di um i nf ar ct i on t at h happ e ne d et b we n t he t wo gr oups was ver y di f f e re nt ,i t was f ound t hat i n t he t r i pi e ves se l l e si on gr oup,32 .1 (9/28)pat i e nt s s uf f er e d f or m myo c ar d i um i f ar n ct i on t ic w e or mor e,whi l e i n t he si gl n e or doubl e ve ss el l esi on gr oup,onl y 8.7 (2/23)pat i ent s di d t he s ame(P< 0 .05).The r es ul t s ar e iven g i n t abl e 4. 1 hbl e 4 C o mp ar is o n on t he f r equency of myo ca rdi um i nf ar ct i on et b we e n gr o up A n d a gr o up B *No si gni f i c ant dif f er ence exi ste d(P> O.05) 2.4 The cul pr it l e si on i n t he t ipl r e vess el l es i on gr o up wer e gr o uped i n t abl e 2:The st enosi s l es i on o ccur r d i e n al l t he t hr e 维普资讯 http://www.cqvip.com 解 放 军 医学 杂 志 2 005年 7月 第 3 O卷 第 7 30 No 7 Ju l y 2 005 Me d J Ch i n PLA Vol — ・ 589 ・ — 2.7 The f ol l ow-up sur ve y t o t he pat i e nt s of t he t ipl r e ve ss e1 c ure d e st,a b nd f ew of t hem ne ed t o be r et r e at d e e xcept t aki ng l esi on gr oup f or one ye ar gave out t he f ol l owi ng r e sul t s:t her e wer e me di ci ne. Onl y one c as e re ce i ve d myoc ar di a1 r ev asc ul a r i za t i on. 48 p at i ent s (7O.6 )r e cei vi g i n nt e v ent r i on, f ar mor e t han t he 7O.6 pat i ent s who r cei e ve d CABG and me di ci ne t r at e me nt(t abl e 5) . pl us st e nt t re at ment t ur ne d i nt o et b t e r o ndi c t i on,but t he r c ur e r i g n Howe ver.s ome of t he pat i e nt s who had re cei ve d i nt e v ent r i on and r at e of a ngi a wa n s hi gh and s o me pat i e nt s w it h re- st e nos i s of t he me di c i ne t r at e ment di d and (or) had t e o under go myoc ar di a l st ent ne ede d t o r ebui l d t he bl ood ve ss e1 .s uc h a r es ul t m a y 1 i e i n r evas cul ar iz at i on and myo ca r di um i nf ar ct i on, whi l e no s uc h t he f ol l ow i ng t hr e e f a ct or s:f i r st l y,t he pat hol og ic al ch an ge sc op e i nci de nt s happ ene d i n t he pat i ent s i t w h CABG of t ipl r e ve ss el l e si on gr o up i s va st; se condl y, most c or on ar y pat i ent s r c ei e ve d t he i nt er ve nt i on. Pat i ent s w it h PTCA i nt e vent r i on t re at ment b el on g t o i nc o mpl et e (par ti a1 )r e bu i l in d g of mI bk 5 Resul t s of one ye ar f ol l ow-up sur v ey t o t he pat i e nt s bl ood ve s se 1,an d t ir h dl y,pat i e nt s wer e not p os i t i ve i n t he me di a1 c t r at e me nt on ant i - aggl ut i at n i g me n di c i ne, a n d de cr a si e g l n i pi d of t ipl r e ves se l l e si on gr oup me di c i ne t r at e ment wa s not enough, wh ic h m a y l a d t e o t he de vel op ment of p at hol ogi c al chan ge d par ts a n d r e - st en os i s of t he st ent . Ther ef or e, c o nce r ni g w n it h t he op er at i ona1 i Tl anner, t he D CABG t r at e ment woul d b e t he f i r s t c hoi c e when t he c o nd it i on of at p i e nt s i s f i t f or s uch a t r at e me nt .For e xampl e,t he v ess e1 of t he CD or c on ar y ar te y r was bl ocked ove r 7 0 ,a nd t he di s a1 t ves se l f o m r t he ar n r ow pl ac e ne ed t o e b unobst u ct r d ,al e o v s ent ic r ul ar f unc t i on i s good[ , except t hat t he pa t i ent s a sk f or t he c or on ar y i nt e v ent r i on. Howe ver, s o me pat i e nt s st i l l c hoos e t he me di al c of c or on ar y ar t er y woul d b e i nf l uenc d by e many f a ct or s,suc h a s t he er p iod of i l l t i me,t he c ar di ova sc ul a r ont ogeny,t he s ever it y of o me s c ar di ovas cul ar i nf l ar nmat i on, and even t he da ma ge of t he i mmuni t y s ys t e m. i t a l o s i ndi at c d t e hat synt hes i ze d anal ysi s shoul d t hough t he e f f ct e of me di al c t r at e me nt i s not s o good.The r ce e nt r ese ar c h al o i s ndi at c e t hat t he f ol l ow i ng dr u gs o ul c d e b se l ct e d : e re c ept or bl c ki o ng a gent s, ACH a gent s, de c re as i g l n i pi d dr ugs, n d a a nt i -t hr o mb o si s dr ugs . Though t he ab ov e dr u gs w il 1 i mpr o ve t he st abi l i t y of uns t abl e pl aque af t e r r ep ai in r g t he br o ken pl aque, t hey o ul c dn' t i mp el myoc ar di a 1 re vas cul ar i z at i on . Thus,i t i s it v a1 t o CD e b a de m on p at i ent s it w h t ipl r e ves sel1 e si on.t hat i s.we mus t f i nd t r at e me nt bec ause of t he exp e ns i ve op er at i on al c ha n ge of CABG. D I t wa s i ndi c at d i e n pr e se nt s t udy t hat t he di f f e r ent sympt oms t he most i nf lue nt i a l dan ger o us f a ct or and t he n make t he t r at e ment i nves t i gat e on t he bi ol og ic br i age me di cal dr ug whi c h c oul d make er p ti ne nt l y . The dat a of t hi s e xp er i ment i ndi at c d t e hat mos t of t he or c on ar y ar ter y t ipl r e ves se l l es i on b el on gs t o t he I V c l a ss . The up t he shor tc o mi ngs of c or on ar y i nt er ve nt i on a nd t he op er at i on al t r at e ment .It i s r ep or te d t hat s uc h a dr u g i s st i l 1 i n r e se ar ch numb er of t he I I I an d IV c l a ss 1 esi ons of t he t ipl r e ves se 1 1 e si on Ref e r ence s ove r pass e d t he s i gl n e or doubl e ve s sel l es i on gr o up s i gni f i c nt a l y, Bo qi Gu. Car d i ov a s cu l ar pa t hol o gy. Bdi i ng: Pe opl e s hyg i e n i c s n dr y ome.I n t he t ipl r e ves s el l es i on gr oup,41.1 of t hem el b on g publ i sh ing house,1992:58— 59 t o myo ca r di um i nf a r ct i on whi l e 52.8 b el on g t o unst abl e an gi na Re n ga o Ye .Cl i ic n a l pr a c t i ce(f if t h e d i t i on) .Be i j i g :Pe n opl e ' s h yg ie ic n D whi c h woul d i ncr a se e t he ch&nce s of ac ut e c or on ar y ar te y r publ i sh in g house,2001,293 CD pe ct or is,whi ch ac c or ds wi t h t he re por t t hat mos t of di s rupt i ons of Fus t e r V,ba imon d 1 ,ba d i mon J J e t a1 .The pat ho gen e s i s of c o r on ar y t he pl aque of unst abl e angi a pe n ct or i s n d myoc a ar di um t ake pl ac e i n a bout 50 a r t er yd is e as e a nd t he a cut e c or on a r y s ynd r ome s . N En gl J MED, a rr n ow pa t hol ogi cal pl a ce s of t he c or on ar y ar te ies r [ ]and I V c l as s st e nosi s i s t he m a i n pat hol ogi c al bas i s of myocar di um i f ar n ct i on[ . 1992;326:242 4 The he ar t f unct i on of most t ipl r e v ess el l es i on pat i e nt s c an st i l l wor k wel l , but t he st or e s t r en gt h of 1995, 92: 657 5 myo ar c di um i s not s o good. The dat a of 1 ef t vent icul r ar i nf a r e t i on.J Am ol C l Car d i ol ,19 88,12:5 6 D 6 pa t i e n t s wi t h mi l d t o mo der at e c or o na r y a r t e y d r is e as e?C ir c ul at i o n, CD 79.4 pat i ent s it w h t ipl r e ves se l l es i on i s l ar ger t han 50 .Thi s ci r c ul at i on i mpr o ve s t he myoc ar di m bl u ood s uppl y ̄ 埘 ;s e condl y, t he ar c di ac mus cl e woul d e b pr ot ct e d by e a dapt at i on t o i s chemi a[ . Li t t l e W C, C on st nt a i ne cu s M, Appl e gat e RJ e t a1 . Ca n c or o na r y angi ̄ raphy predi ct the si te of a subsequent myocard ia l i nf arc ti on i n pat i ent s w it h si gl n e or doubl e ve ss e1 1 es i on. but t he LVEF of a y m l i e i n t he f ol l ow in g r as e o ns:f i r s t,t he bui l di g of n c ol l at e r al Ambr os e JA,Ta nne nb au m MA,Al ex op ou lo s D e t a1 .Angi c gr a ph ie progressi on of or c onary art er y ise d ase i n the devel opment of myocard ial angi ogr aphy i n t is h e xp er i ment s howe d t hat t he l e f t ve nt ic r l e f unc t i on of pat i e nt s it w h t ipl r e ve ss el1 es i on was wor s e t han t hat of 刚 k E,Shah PK,Fust er v.Coronar y pl aque d is u pt r i on. Ci rcu lati on. 1988,78:1157 7 Fust er V, Fr ye RL, Kennedy M A et a1. The rol e of c ol l atera l ireul t ati on i n vari ous coronary syndrome.C ir cul at i on,1979,59:1137 — 1144 st unne d myo car di m and myoc u ar di um h ib e rnat i on whi c h wer e 8 Gr ol l i e r G,C o mme au P,Fouc aul t J P e t a1 . Ang i opl a s t y of c hr o ic n a us c d by t e he i sc he mi a i n di f f e r ent par ts . As t o t he f i ni s he d t ot ll a y o c c l ud d e or c on ar y ar t e r i s :us e ef u l n e s s o f r e t r o gr a de o pa c i ic f at i on exer c i s e t est i g ,t n he r at e of t he t ipl r e ves se l 1 si e on t o posi t i ve of the occl ude d vessel vi a t he cont ra lat era l c or onary arter y obvi ousl y hi gher t ha n t hat of t he t wo ves el s l si e on gr o up,wh ic h J,1 987,11 4:13 24— 1 32 8 a y m e due b t o t he vas t p at hol og ic al chan ge s c op e of t ipl r e ves se l l e si on gr o up t hat a n c l a d t e o s t or e s t r engt h of myoc ar di um ,whi c h i n t ur n il w l e as i l y r e sul t i n t he i s chemi a whe n pl ayi g. n Mor e over,i n t he f ol l ow- up vi s i t s t o t he pat i e nt s w it h t ipl r e ves s  ̄l l es i on we f ound t hat t he at p i e nt s wi t h CAI 3 G t r at e me nt wer e . 9 Pa r r a t t J R T_ he Di s ∞v er y of I s c he c Pr ec 0 ndi t I o ni n Am Hear t Ca l av a S c Res,1993,27:688 (2 OO5 一 O3 — 22收稿 2OO 5一 O6一 O8修回) ( 本文编辑 张金桐)
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