明胶海绵颗粒混合糊剂栓塞治疗经皮冠状动脉介入治疗术中冠状动脉穿孔的安全性和疗效分析  

Analysis on the Safety and Efficacy of Large and Small Gelfoam Particles-mixed Paste Embolization for Coronary Artery Perforation During Percutaneous Coronary Intervention

作　　者：田原[1,2] 袁莹 路航[3] 邱洪 李向东[1] 杨跃进[1] TIAN Yuan;YUAN Ying;LU Hang;QIU Hong;LI Xiang-dong;YANG Yue-jin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing (100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037 [2]乌鲁木齐市友谊医院 [3]乌鲁木齐市友谊医院心血管内科

出　　处：《中国循环杂志》2018年第12期1170-1175,共6页Chinese Circulation Journal

基　　金：国家自然科学基金面上项目(81774292);中国医学科学院医学与健康科技创新工程项目(2016-12M-1-009)

摘　　要：目的:回顾性分析比较采用大、小两种颗粒明胶海绵混合糊剂与单一大颗粒或小颗粒明胶海绵混悬液栓塞治疗经皮冠状动脉介入治疗(PCI)术中冠状动脉穿孔(CAP)的安全性和疗效差异。方法:汇总中国医学科学院阜外医院2015-01至2016-12期间冠心病中心所有行PCI病例资料,选取术中出现Ⅱ型和Ⅲ型CAP并用单一大颗粒(350～560μm)明胶海绵(大颗粒组)、单一小颗粒(150～350μm)明胶海绵(小颗粒组)或大小两种颗粒明胶海绵混合糊剂(混合颗粒组)栓塞处理的患者,收集和比较分析三组患者的基线资料、介入相关指标、栓塞术后效果等情况。结果:59 957例行PCI的患者中,符合入组标准的CAP患者共45例(0.08%)。患者平均年龄(60.2±10.6)岁,男性39例(86.7%)。大颗粒组、小颗粒组、混合颗粒组患者分别有11例(24.4%)、22例(48.9%)和12例(26.7%)。三组间Ⅱ型、Ⅲa型及Ⅲb型CAP患者比例差异均无统计学意义(P均>0.05)。41例(91.1%)患者栓塞治疗成功。4例栓塞失败的患者行补救性覆膜支架置入后CAP愈合,术后未出现其他严重并发症。大颗粒组、小颗粒组、混合颗粒组的栓塞治疗成功率分别为72.7%(8/11)、95.5%(21/22)和100%(12/12),栓塞术后无复流发生率分别为18.2%(2/11)、4.5%(1/22)和0%(0/12),慢血流发生率分别为27.3%(3/11)、27.3%(6/12)和8.3%(1/12),慢血流和无复流总发生率分别为45.5%(5/11)、31.8%(7/22)和8.3%(1/12),组间比较差异均无统计学意义(P均>0.05)。结论:对于PCI术中出现的CAP,用大、小两种颗粒明胶海绵混合糊剂栓塞治疗安全、有效。与单纯大颗粒或小颗粒明胶海绵混悬液相比,两种颗粒明胶海绵混合糊剂或有助降低术中无复流和慢血流发生。Objectives: To analyze the safety and efficacy of large and small gelfoam particles-mixed paste embolization versus pure large gelfoam particle suspension or pure small gelfoam particle suspension for coronary artery perforation(CAP) during percutaneous coronary intervention(PCI).Methods: We screened for patients underwent PCI from January 2015 to December 2016 in Fuwai Hospital, and enrolled CAP patients who treated by gelfoam embolization, patients were divided into pure large particle(350-560 μm) gelfoam(large particle group), pure small particle(150-350 μm) gelfoam(small particle group) and gelfoam particles mixed paste(mixed particles group). The baseline data, intervention related indications, and embolization efficacy were analyzed and compared among groups.Results: A total of 45 CAP patients out of 59,957 patients undergoing PCIs(0.08%) treated by gelfoam embolization were included in our study. The mean age was(60.2±10.6) years old, and 39(86.7%) were male. The number of patients in pure large particle group, pure small particle group and mixed particles group was 11(24.4%), 22(48.9%) and 12(26.7%), respectively. Percent of type II, IIIa and IIIb CAP was similar among the three groups. A total of 41 patients(91.1%) were embolized successfully, the other 4 cases(8.9%) with failed with gelfoam embolization were treated by covered stents and discharged without complications. The embolization success rate of the three groups was 72.7%(8/11), 95.5%(21/22) and 100%(12/12), respectively; no reflow rate was 18.2%(2/11), 4.5%(1/22) and 0%(0/12), respectively; slow flow rate was 27.3%(3/11), 27.3%(6/22) and 8.3%(1/12), respectively; combined rate of no reflow and slow flow was 45.5%(5/11), 31.8%(7/22) and 8.3%(1/12), respectively. Compared with other two groups, embolization with mixed paste tended to be safer and more effective; however, neither reached statistical significances. Conclusions: For CAP during PCI, embolization with large and small gelfoam particles mixed paste is safe and effective. Compared wit

关 键 词：经皮冠状动脉介入治疗 冠状动脉穿孔 明胶海绵颗粒 混合糊剂 疗效 

分 类 号：R54[医药卫生—心血管疾病]