磁导航系统在老年冠心病患者介入治疗中的应用研究  

Safety and efficacy of magnetic navigation system on percutaneous coronary intervention in elderly patients

作　　者：郝丽军[1] 杨吉猛[1] 王晖 宋雪荣 李春坚[1] 王连生[1] 杨志健[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029 [2] 江苏盛泽医院心脏科

出　　处：《中华老年医学杂志》2014年第10期1041-1044,共4页Chinese Journal of Geriatrics

基　　金：基金项目：江苏省自然科学基金（BK2012648）

摘　　要：目的 探讨磁导航系统在老年冠心病患者介入治疗中的有效性和安全性。 方法 连续选择经磁导航辅助介入治疗的老年冠心病患者62例（磁导航组）,治疗靶病变62处;再按1∶1配比的病例对照研究,从同期资料库中筛选常规经皮冠状动脉介入治疗的62例患者作为对照（常规治疗组）,分别记录导丝通过病变时间、X线暴露时间、对比剂用量及围术期并发症进行统计分析. 结果 磁导航组和常规治疗组导丝靶血管通过率98.4％（61/62）与100％（62/62）、导丝通过病变时间[（83.3±66.8）s与（84.3±54.6）s]和X线暴露时间[[（63.9±54.9）s与（64.7±4.1）s]比较差异均无统计学意义（均P＞0.05）.在A/B1型病变中,磁导航组和常规治疗组对比剂使用量分别为（2.8±0.8）ml与（3.4±0.9）ml（P＞0.05）;在B2和C型等复杂病变中,磁导航组对比剂使用量分别为（5.9±3.3）ml与（9.7±5.4） ml,低于常规治疗组的（8.0±3.3） ml与（14.5±6.1） ml（均P＜0.05）.两组介入术后均达到心肌梗死溶栓试验（TIMI）血流分级3级血流灌注,术中未出现与应用导丝相关的冠状动脉夹层、穿孔等并发症;随访至出院未发生心绞痛复发、再次心肌梗死、死亡等心血管复合事件。 结论 磁导航系统可用于老年冠心病患者的介入治疗,并能降低复杂病变对比剂用量。Objective To investigate the safety and efficacy of magnetic navigation system （MNS） on percutaneous coronary intervention （PCI） in elderly patients.Methods 62 consecutive patients aged ≥60 years with 62 lesions undergoing the MNS assisted PCI （MPCI） were selected as MPCI group,and 62 matched patients undergoing conventional PCI （CPCI） selected from the same concurrent database were considered as CPCI group.Time for guidewire passing lesion,fluoroscopy time,contrast doses and procedure related complication in the two groups were recorded and analyzed.Results Of the 62 culprit lesions in MPCI,61 were crossed by guidewire successfully giving a success rate of 98.4%,while the success rate was 100% in CPCI group （P〉0.05）.The procedure time [（83.3±66.8） seconds vs.（84.3±54.6） seconds] and the fluoroscopy time[（63.9±54.9） seconds vs.（64.7±44.1）seconds] for crossing the lesion were very similar between the magnetic and conventional PCI groups （t=0.009,0.007,both P〉0.05,respectively）.In type A/B1 lesions,the dose of contrast agent[（2.8±0.8） ml vs.（3.4±0.9 ml）] had no difference between MPCI and CPCI group （t=2.709,P〉0.05）.But when lesion complexity increased from type B2 to C,as compared with CPCI group,a significantly less contrast was needed in MPCI group in type B2[（5.9±3.3） ml vs.（8.0±3.3）ml,t=5.161,P=0.027] and type C[（9.7±5.4） ml vs.（14.5±6.1）ml,t=7.922,P=0.007].Perfusion in the two groups which reached to thrombolysis in myocardial infarction trial （TIMI） perfusion grade 3.No intervention-related complications such as coronary artery dissection and perforation were found during operation.No major adverse cardiac events were observed in either the MPCI or CPCI group until discharge from hospital.Conclusions MPCI is feasible in elderly patients,and it can reduce the contrast agent dose in patients with more complex lesions.

关 键 词：血管成形术 经腔 经皮冠状动脉 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]