摘要
目的比较简单策略治疗冠状动脉分叉病变过程中边支球囊保护技术与边支导丝保护技术的临床效果,为分叉病变治疗策略的选择提供参考。方法入选接受简单策略治疗的冠状动脉分叉病变患者90例,分叉病变分型为Duke D或Duke F型,边支血管直径>2.0 mm,有明显血流动力学意义。按随机数字表法分为边支球囊保护组(48例)及边支导丝组(42例),观察2组手术成功率、边支受累及并发症情况,并对主要不良心血管事件(MACE)、病变血管再狭窄情况进行随访。结果 2组间患者临床基线资料及分叉病变特点差异无统计学意义。2组主支血管经皮冠状动脉介入(PCI)成功率差异无统计学意义(100.0%vs.97.6%,P>0.05),边支球囊保护组边支无复流发生率(1.0%vs.19.0%)、边支对吻率(4.2%vs.23.8%)、手术时间[(56.40±11.71)s vs.(72.60±10.62)s)]、曝光时间[(9.86±1.82)s vs.(12.24±2.32)s]、对比剂用量[(90.54±15.26)m L vs.(118.16±18.64)m L)]均低于边支导丝组(P<0.05)。术后随访12个月,边支球囊保护组MACE发生率低于边支导丝组(16.7%vs.38.1%)。2组主支血管再狭窄率(2.1%vs.4.8%)、最大狭窄程度[(19.24±4.43)%vs.(21.46±5.24)%]差异均无统计学意义,但边支血管开口最大狭窄程度小于边支导丝组[(51.20±4.52)%vs.(72.46±8.64)%,P<0.01]。结论简单策略治疗冠状动脉分叉病变过程中,应用边支球囊保护技术较边支导丝技术具有并发症少、手术时间及曝光时间短、造影剂用量少,MACE发生率低及对边支血管开口狭窄程度影响小等优点,是临床实践中治疗冠状动脉分叉病变有效、可行的方法。
Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique insimple strategy. Methods Ninety patients with bifurcation lessions （Duke D or F type） who received the side branch protectiontechnique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailedballoonprotection group （n=48） and jailed guidewire group （n=42）. The process operating, procedural success of percutaneouscoronary intervention （PCI） and percutaneous transluminal coronary angioplasty （PTCA）, complications and the results of followupwere investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailedballoongroup and jailed guidewire group （P 〉 0.05）. The procedural success rate of PCI was 100% in jailed-balloon group and97.6% in jailed guidewire group, no significance difference user between two groups （P 〉 0.05）. The perioperative complications（the rate of no reflow） was lower in jailed-balloon group than those of jailed guidewire group （1.0% vs. 19.0%, P 〈 0.05）. Theprocedural success rate of PTCA were lower in jailed-balloon group than that of jailed guidewire group （4.2% vs. 23.8%, P 〈 0.01）.The total operation time [（56.40±11.71） s vs. （72.60±10.62） s],exposing time [（9.86±1.82） s vs.（12.24±2.32）s] or amount of usedcontrast agent [（90.54±15.26） mL vs. （118.16±18.64） mL] were significantly lower in jailed-balloon group compared with thoseof jailed guidewire group （P〈0.05）. At the 12-month follow-up, the MACE was lower in the jailed-balloon group than that ofjailed guidewire group （16.7% vs. 38.1%, P 〈 0.05）. The restenotic rate （2.1% vs. 4.8%, P 〉 0.05） and the maximum restenoticlevel （19.24% vs. 21.46%,P 〉 0.05） in the main branch were not significant different between jailed-balloon group and jailedguidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that ofjailed guidewire group （51.2% vs. 72.46%, P 〈 0.01）. Conclusion The jailed-balloon technique reduces the operationcomplications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch withsimple strategy is safe and effective in treatment of bifurcation lesions.
出处
《天津医药》
CAS
2016年第9期1115-1119,共5页
Tianjin Medical Journal
关键词
冠心病
心肌梗死
血管成形术
经腔
经皮冠状动脉
心肌再灌注
心肌再灌注损伤
边支球囊保护技术
coronary disease
myocardial infarction
angioplasty, transluminal, percutaneous coronary
myocardialreperfusion
myocardial reperfusion injury
jailed balloon technique
