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各位朋友：

大家好，现在是“每天健康三分钟”时间，我是安阳道简医院的医生白传威。经常有刚做完支架的患者会问我们，何时来复查和复查具体项目有哪些，那么今天我就和大家聊聊冠脉支架术后复查的问题。

冠状动脉支架植入术是一种机械性的介入治疗手段，它是将金属支架永久性地置放于冠状动脉病变处，经球囊扩张释放或自膨胀方式支撑住血管壁，以保持冠状动脉管腔的通畅，降低急性心肌梗死死亡率。术后的复查对检测手术疗效、及时发现危险因素起着至关重要的作用，那么，做过冠状动脉支架手术的患者该如何复查呢？

一般来说，如果支架手术顺利，供应心脏最主要的血管狭窄解决，实现完全血运重建，患者的心肌缺血的症状会明显减轻。目前的支架材料或者技术都已经很成熟，做完支架患者如果没有典型的心肌缺血症状（发作性胸痛胸闷，也是做支架之前那种胸闷胸痛的不舒服症状消失），这种情况说明支架减除了血管狭窄，手术成功，没有出现再狭窄，也没有支架血栓形成，这种情况无需过多复查。其实做了支架以后最怕发生的是支架血栓，支架再狭窄，上消化道出血，所有是否再现心肌缺血症状非常关键。有缺血随时就医复查，无症状的话，可以按照以下时间复查。

1、支架术后1个月

冠心病患者常合并高血压，糖尿病及高血脂等危险因素，植入支架后需要强化抗血小板治疗，即双抗治疗及强化降脂治疗，一个月需要检查血常规、便常规+潜血，尿常规，凝血功能、生化（血糖+血脂+肾功能+肌酸激酶）、心电图、心脏超声（心肌梗死患者）。血常规及便常规+潜血，目的主要观察强化的抗血小板的治疗是否会导致隐匿性消上化道出血，及抗血小板药物会不会对血小板或白细胞数量造成影响。复查生化重点看血脂+肌酸激酶+肝功能，因为他汀类药物造成肝功能损伤和肌肉损伤，导致转氨酶增高概率偏高，同时观察血脂是否达标，尤其低密度胆固醇（L-LDL),药物是否会出现副作用，第一个月非常关键。

【英文版】

How to review after coronary stent implantation?

Dear friends, nice to meet you!Now it is time for “health talk for three minutes every day”,My name is Bai Chuanwei, a doctor of Anyang Daojian Hospital.Often patients who have finished coronary stent implantation will ask the doctor how long to come to the hospital for review after the operation and what specific items need to be reviewed. Today, I'd like to talk about the problems related to the review after coronary stent implantation.

Coronary artery stent implantation is a kind of mechanical interventional therapy.Coronary artery stent implantation is a kind of mechanical interventional therapy.It is to place the metal stent permanently in the lesion of coronary artery and support the vessel wall by balloon dilation or self expansion, so as to ensure the patency of coronary artery lumen and reduce the mortality of acute myocardial infarction. The review after coronary stent implantation plays an important role in the detection of surgical efficacy and timely detection of risk factors. So, how to review the patients who have undergone coronary stent implantation?

Generally speaking, if the operation of coronary artery stent implantation is successful,the problem of vascular stenosis of the main blood supply to the heart is solved, and complete revascularization is achieved, the symptoms of myocardial ischemia will be significantly reduced. The current stent materials and technology have been very mature.If patients after coronary stent implantation do not have typical symptoms of myocardial ischemia(paroxysmal chest pain, chest tightness, chest pain and other discomfort symptoms in patients with coronary heart disease before stent implantation will disappear), this situation shows that stent implantation can reduce vascular stenosis, and the operation is successful.There was no restenosis or stent thrombosis, which did not need to be reviewed.

In fact, the most dangerous complications after stenting are stent thrombosis, stent restenosis and upper gastrointestinal bleeding, so it is very important for patients to have myocardial ischemia symptoms again.Go to the hospital for reexamination at any time when there are ischemic symptoms. If there are no symptoms, reexamination can be carried out according to the following time.

1. One month after stent implantation

Patients with coronary heart disease are often associated with hypertension, diabetes, hyperlipidemia and other risk factors.After stent implantation, we need to strengthen antiplatelet therapy, that is, dual anti therapy, but also strengthen lipid-lowering therapy. Blood routine, stool routine, fecal occult blood, urine routine, coagulation function,blood biochemistry (including blood glucose, blood lipid, renal function, creatine kinase), electrocardiogram and cardiac ultrasound (for patients with myocardial infarction) should be checked every month.

The main purpose of routine blood test, stool routine test and stool occult blood test is to observe whether intensive antiplatelet therapy will lead to occult upper gastrointestinal bleeding, and whether antiplatelet drugs will affect the number of platelets or white blood cells.Review of blood biochemistry, focusing on blood lipids, creatine kinase, liver function,because statins can cause liver function damage and muscle damage,it is likely to lead to increased transaminase,at the same time to observe whether the blood lipid level is up to standard,especially the level of low-density cholesterol (L-LDL), for the first month to determine whether the drug has side effects is very important.