在冠状动脉临界病变中血管内超声与压力血流储备的实际应用  

Application of intravascular ultrasound and pressure flow reserve in intermediate coronary artery disease

作　　者：方哲[1] 王鹏飞[2] 王瑞[3] 张新勇[4] 李扬[5] 杨士伟[1] 胡宾[1] 贾得安[1] 吉庆伟[4] 马秀华[6] 周玉杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内12病房,100029 [2]北京安贞医医院-北京市大兴区人民医院院办 [3]北京安贞医医院-北京市大兴区人民医院影像科 [4]北京安贞医医院-北京市大兴区人民医院急诊科 [5]北京安贞医医院-北京市大兴区人民医院心外科11病房 [6]北京安贞医医院-北京市大兴区人民医院心血管诊疗中心

出　　处：《心肺血管病杂志》2017年第3期207-210,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市朝阳区科技计划(CYSF1618)

摘　　要：目的:研究血管内超声(IVUS)与压力血流储备(FFR)在冠状动脉临界病变中的长期随访研究。方法:2014年5月至2015年5月,经过冠状动脉造影(QCA)分析证实病变狭窄处于临界病变的住院患者78例,排除20例,共计58例患者入选。对QCA测定直径狭窄30%~50%临界病变的患者进行随机分组:血管内超声组29例,压力血流储备组29例。通过压力导丝测定相关数值<0.75,IVUS最小管腔面积≤4.0mm2或者面积狭窄率≥70%的患者,积极给予介入干预治疗。术后规律服用药物,观察两组围手术期间以及1年随访的主要心血管事件。结果:IVUS组依据临界病变的指标进行判定,有8例超出临界病变的标准,其中发现前降支病变5例,混合斑块1例,6例明显钙化灶;依据FFR数值<0.75患者共计7例,给予介入干预治疗。术后给予规律冠心病二级预防。IVUS组3例失访,随访率90%。1例再发作心绞痛入院介入治疗;FFR组4例失访,随访率86%。3例再发作心绞痛入院介入治疗。结论:对于临界病变的患者,采用IVUS的方法能够检测出更多易损斑块等情况,联合QCA结合FFR能够提供临界病变患者危险分层依据,术中、术后FFR值越高,临床不良事件发生率就越低,患者长期预后越好。Objective：This study aims to compare the prognosis of patients with intermediate coronary stenosis by fractional flow reserve （FFR） and intravascular ultrasound （IVUS） in long-term follow-up. Meth- ods ： From May 2014 to May 2015, after coronary angiography （ quantitative coronary angiography, QCA） anal- ysis confirmed the stenosis （ at least 4 position imaging confirmed diameter stenosis rate between 30% - 50% ） 78 cases, 20 cases were excluded, a total of 58 patients were enrolled. The patients were randomly divided into 2 group ： intravascular ultrasound （ n = 29 ）, fractional flow reserve （ n = 29）, Determination 〈 0. 75 by pressure wire, or IVUS ≤4. Omm2 patients with minimal lumen area or area stenosis rate was higher than 70% , patients were given coronary intervention treatment, and observed two groups of postoperative hospital stay, 30 days, 3 months, 9 months and 1 year, the major cardiovascular events. Results： IVUS and FFR for coronary interven- tion treatment subgroup analysis, measured minimum lumen diameter were （ 1.86 ± 0. 34） mm vs. （ 1.94±0. 16）mm, P = 0. 986,respectively. Through the Kaplan regression model showed that the two groups has down trend closely, P = 0. 996, did not show the obvious statistical significance. Conclusion： In the intermediate lesions patients, the frequency of severe stenosis detected by IVUS is high, for patients with critical lesions, used IVUS method to detect more vulnerable plaques, QCA combined with FFR can provide critical disease risk stratification, for intraoperative and postoperative FFR clinical value is higher.

关 键 词：临界病变 血管内超声 压力血流储备 

分 类 号：R54[医药卫生—心血管疾病]