冠状动脉长支架植入治疗冠状动脉长病变的效果和安全性  

Clinical observation of percutaneous coronary intervention for long lesions

作　　者：倪飞华[1] 邬盛昌[2] 吴锋 王飞宇 秦永文 

机构地区：[1]浙江省人民医院国际医疗中心,浙江杭州310014 [2]浙江省人民医院呼吸内科,浙江杭州310014 [3]上海长海医院心血管内科

出　　处：《上海医学》2015年第2期139-142,共4页Shanghai Medical Journal

摘　　要：目的评价冠状动脉长支架植入治疗冠状动脉长病变的有效性和安全性。方法回顾性分析2011年6月—2012年5月在上海长海医院行经皮冠状动脉介入治疗(PCI)的418例冠状动脉性心脏病长病变(冠状动脉病变长度>20mm)患者的临床资料,根据植入冠状动脉支架的长度,分入短支架组(124例,植入支架的长度<20mm)和长支架组(294例,包括植入支架的长度为21~<29mm、29~<36mm和重叠植入支架),比较两组PCI的手术特点、术中急性并发症和随访12~18个月的主要心脏不良事件(MACE)发生情况。结果长支架组的载脂蛋白(Apo)B水平、ApoB/ApoA1比值、重度吸烟和糖尿病的构成比、危险因素个数均显著高于短支架组(P值分别<0.05、0.01)。长支架组Gensini积分、围术期肌钙蛋白I(cTnI)升高阳性率,以及冠状动脉球囊预扩张、冠状动脉球囊后扩张、非ST段抬高型心肌梗死、术中急性分支血管闭塞和分支血管开口狭窄加重的构成比均显著高于短支架组(P值分别<0.01、0.05)。结论冠状动脉长支架植入的手术难度大,术中操作复杂,易发生术中并发症,但长支架植入后的近中期疗效佳且安全。Objective To evaluate the efficacy and safety of percutaneous coronary intervention （POD for long lesions. Methods A total of 418 cases who were admitted to Changhai Hospital between June 2011 and May 2012 and underwent PCI were enrolled in this retrospective study. According to the length of coronary artery stents, they were divided into short stent group （〈20 mm, n = 124） and long stent group （including 21 - 〈29 mm, 29-〈36 mm, and overlap stent, n = 294）. Characteristics of PCI, intraoperative complications and major adverse cardiac events （MACE） at 12- 18 months of follow-up were compared between the two groups. Results The incidence of diabetes, apolipoprotein （Apo） B level, ratio of Apo B to Apo A1, the proportion of heavy smokers, and risk factors in the long stent group were significantly more than those in the short stent group （P^0.05, 0.01）, so were the Gensini score, positive rate of perioperative troponin-I, proportion of balloon predilation, proportion of subsequent balloon dilation, proportion of non-ST segment elevation myocardial infarction, incidence of coronary artery branch stenosis and occlusion （P〈0.05, 0.01）. Conclusion Long drugeluting stent implanting is technically difficult and complicated with a high risk of intraoperative complications, but medium-term therapeutic effect is safe and favorable.

关 键 词：冠状动脉性心脏病 长病变 药物洗脱支架 

分 类 号：R541.4[医药卫生—心血管疾病]