分支血管球囊预埋治疗老年冠状动脉分叉病变患者的疗效和安全性  

Effectiveness and safety of the side-branch balloon pre-imbedding technique on coronary bifurcation lesions in elderly patients

作　　者：乔勇[1] 鄢高亮[1] 王栋[1] 王婧[1] 孔文杰[1] 马根山[1] 汤成春[1] 

机构地区：[1]东南大学附属中大医院心内科,南京210009

出　　处：《中华老年医学杂志》2016年第2期151-155,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金（81170105,81370225）

摘　　要：目的观察分支血管球囊预埋技术治疗老年冠状动脉（冠脉）分叉病变的疗效和安全性。方法回顾性分析2011年5月至2013年5月在我院住院的老年冠脉分叉病变患者i1I例，其中行分支球囊预埋59例，行分支单纯导丝保护52例，比较两组患者术后即刻分支血管血流及置人支架情况，住院期间、术后6个月及12个月主要不良心脏事件（MACE）发生率，术后6个月冠脉造影血管血流情况。结果两组患者基础临床特征、冠脉病变分布、主支血管及分支血管病变长度及内径、主干与分支之间的夹角、主支血管置人支架长度和个数、住院期间、术后6个月两组MACE发生率差异无统计学意义（P〉0．05）。术后即刻造影结果显示，主支及分支血流急性心肌梗死溶栓试验（TIMI）3级、主支残余狭窄〉25％患者差异无统计学意义（P〉0．05），球囊预埋组分支血管残余狭窄〉50％者、分支需要置人支架者低于导丝保护组8．5％（5／59）与23．i％（12／52）及42．4％（25／59）与6i．5％（32／52），均P〈0．05。术后6个月冠脉造影显示，两组主支血管血流TIMl3级，主支残余狭窄〉25％者差异无统计学意义（P〉0．05），球囊预埋组分支血管的血流TIM13级者高于导丝保护组90．2％（37／41）70．6％与（24／34）（P〈0．05），残余狭窄〉50％者低于导丝保护组7．3％（3／41）与23．5％（8／34）（P〈0．05），分支血管的狭窄程度、晚期管径丢失及支架再狭窄率均低于导丝保护组（P〈0．01）。术后12个月球囊预埋组MACE发生率低于导丝保护组11．9％（7／59）与26．9％（14／52）（P〈0．05）。球囊预埋组手术相关费用更低，（55113±968）元与（61023±131i）元，但差异无统计学意义（P〉0．05）。结论分支血管球囊预埋技术治疗老年冠脉分叉病变是安全的，其近远期疗效优于行分支单纯导丝保护技�Objective Tostudy the effectiveness and safety of the side-branch （SB） balloon pre- imbedding technique on coronary bifurcation lesions （CBLs） in elderly patients. Methods A retrospective analysis was conducted on 111 elderly patients with CBLs in our hospital from January 2011 to January 2013, of whom 59 patients received SB balloon pre-imbedding and 52 patients received SB wire protection. The immediate blood flow of the side-branch after treatment, the performance of the stent, and major adverse cardiovascular events （MACE） during hospitalization, 6 and 12 months after treatment, and coronary angiography 6 months after treatment were compared between the two groups. Results There were no statistical differences between the two groups in clinical characteristics, lesion distribution, length and diameter of MB or SB, bifurcation angle, length and number of main branch（MB） stenting, or MACE during hospitalization and 6 months after treatment （each P〉0.05）. There was no statistical difference in immediate postoperative angiography between patients with thrombolysis in myocardial infarction （TIMI） grade 3, coronary stenosis more than 25 % in the MB （P〉0.05）. The percentages of patients with coronary stenosis more than 50 % in SB and patients who needed SB stenting were lower in the balloon pre-imbedding group than in the wire protection group 8.5% （5/59） w 23.1% （12/52）, 42.4% （25/59） vs. 61.5% （32/52）, each P〈 0. 051. After 6 months of treatment, there was no statistical difference in coronary angiography in TIMI grade 3 of MB and coronary stenosis more than 25% in MB between the two groups （P〉0.05） Also, the percentage of patients with TIMI grade 3 in SB was higher in the balloon pre-imbedding group than in the wire protection group （37/41 vs. 24/34, P〈0.05） the percentage of patients with coronary stenosis more than 50% in SB was lower in the balloon pre-imbedding group than in the wire protection group （3/41 vs. 8/34, P〈0.05） and the degree o

关 键 词：冠状动脉疾病 冠状动脉分叉病变 支架 治疗结果 

分 类 号：R543.3[医药卫生—心血管疾病]