天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (9): 1115-1119.doi: 10.11958/20160088

• 临床研究 • 上一篇    下一篇

边支球囊保护技术在冠状动脉分叉病变介入治疗中的效果分析#br#

刘海亮， 张瑞波， 侯渊博， 张超红△， 陈爱侠#br#   

  1. 三门峡， 黄河三门峡医院心血管内科（邮编 472000）
  • 收稿日期:2016-02-29 修回日期:2016-06-25 出版日期:2016-09-15 发布日期:2016-09-28
  • 通讯作者: 张超红 E-mail:lhl10591716@126.com
  • 作者简介: 刘海亮（1981）， 男， 主治医师， 硕士， 主要从事冠心病与临床研究

Study of the clinical effects of jailed-balloon protection technique for the treatment of bifurcation lesions of percutaneous coronary intervention

LIU Hailiang, ZHANG Ruibo, HOU Yuanbo, ZHANG Chaohong△, CHEN Aixia   

  1. Department of Cardiology, Huanghe Hospital in Sanmenxia, Henan 472000, China
  • Received:2016-02-29 Revised:2016-06-25 Published:2016-09-15 Online:2016-09-28
  • Contact: ZHANG Chaohong E-mail:lhl10591716@126.com

PDF (PC)

3788

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）mL vs.（118.16±18.64）mL）］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。

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

Abstract: Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique in simple strategy. Methods Ninety patients with bifurcation lessions (Duke D or F type) who received the side branch protection technique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailedballoon protection group (n=48) and jailed guidewire group (n=42). The process operating, procedural success of percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA), complications and the results of followup were investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailedballoon group and jailed guidewire group (P > 0.05). The procedural success rate of PCI was 100% in jailed-balloon group and 97.6% 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). The procedural 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 used contrast agent [(90.54±15.26) mL vs. (118.16±18.64) mL] were significantly lower in jailed-balloon group compared with those of jailed guidewire group (P＜ 0.05). At the 12-month follow-up, the MACE was lower in the jailed-balloon group than that of jailed guidewire group (16.7% vs. 38.1%, P < 0.05). The restenotic rate (2.1% vs. 4.8%, P > 0.05) and the maximum restenotic level (19.24% vs. 21.46%， P > 0.05) in the main branch were not significant different between jailed-balloon group and jailed guidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that of jailed guidewire group (51.2% vs. 72.46%, P < 0.01). Conclusion The jailed-balloon technique reduces the operation complications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch with simple strategy is safe and effective in treatment of bifurcation lesions.

Key words: coronary disease, myocardial infarction, angioplasty, transluminal, percutaneous coronary, myocardial reperfusion, myocardial reperfusion injury, jailed balloon technique