[基础医学]唐熠达-血小板低反应性至支架内血栓病例分析一例.pdf

Could the low respponse to anti- platelet therapy be improved? YidaYida Tang,Tang, MD,MD, PhDPhD Dept. of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences 患者情况 • Age ：45 Y Gender ：Male • Chief Compliant ： ExertionalExertional chestchest discomfortdiscomfort forfor 99 monthsmonths, continuouscontinuous chest pain for 1 hour. • History of present illness (Part I) ： TheThe patientpatient startedstarted feelingfeeling thethe exertionalexertional chestchest discomfort 9 months ago, mainly after jogging or climbing hillshills. TheThe chestchest discomfortdiscomfort disappeareddisappeared afterafter beingbeing restrest forfor 8-10 min. The CAG in July, 2009 showed: RCA 100％, LAD100LAD100％％, andand LCX90LCX90％％. • History of present illness (Part II) ： We put 4 stents in the RCA-CTO on Aug 17, 2009. To insure the safety, we separately did another PCIPCI, puttingputting stentsstents inin LADLAD--CTOCTO andand LCXLCX withwith 22 stents in each vessel on Aug 24. In the morning on Aug 27, the day he is going to be discharge, he experiencedexperienced thethe continuouscontinuous chestchest painpain accompaniedaccompanied with sweating. •• PastPast history:history: Hypertension for 5 yrs, the highest BP is 145/100mmHg, calcium blocker to maintain the BP at 120/90mmHgg. Hypyperlippidemia for 10 yyrs. Dined DM. Been on smoking for 20 yrs, 20 per day. • Physical examination ： Pale face, still sweating on forehead. BP: 140/90mmHg, HR: 63bpm. No rales and no murmurs. No edema in the lower limb. Body weight 70KG。 PreviousPrevious ECGECG onon thethe firstfirst admissionadmission CurrentCurrent ECGECG ((5:135:13Am;Am; AugAug 2727, 2009)2009) CurrentCurrent ECGECG (6(6::00Am;00Am; AugAug 2727, 2009)2009) Cardiac enzymes and Troponin on admission CTnT(ng/