球囊扩张压力、时间及周期对动脉再狭窄与外膜滋养血管增生的影响  

The effect of balloon dilation pressure,time and period on arterial restenosis and extravasation

作　　者：董波[1] 叶猛[2] 王暐 王夕栩 龚亦群 洪彪[1] DONG Bo;YE Meng;WANG Wei(Department of Vascular Surgery,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China;Department of Vascular Surgeu,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200336,China.)

机构地区：[1]上海交通大学医学院附属同仁医院血管外科 [2]上海交通大学医学院附属仁济医院血管外科,上海200336

出　　处：《临床和实验医学杂志》2018年第16期1747-1751,共5页Journal of Clinical and Experimental Medicine

基　　金：上海市卫生和计划生育委员会科研课题(编号:201440430);上海交通大学医学院附属同仁医院院级项目(编号:TR201411)

摘　　要：目的探讨不同压力、时间、周期球囊扩张后动脉外膜滋养血管增生与动脉再狭窄关系。方法前瞻性选取2015年1月至2017年7月收治的下肢动脉硬化闭塞症患者80例,术前CT血管造影(CTA)提示股浅动脉狭窄超65%。根据球囊扩张压力、时间、周期不同分为4组:Ⅰ组(n=20)6 atm,2 min×1次;Ⅱ组(n=20)10 atm,2 min×1次;III组(n=20)6 atm,4 min×1次;Ⅳ组(n=20)6 atm,2 min×2次,间隔5 min。于术前、术后3 d、术后3个月行踝肱指数测定(ABI)、多普勒超声及超声造影检查,评估不同球囊扩张压力、时间及周期对ABI、动脉狭窄程度、血流动力学改善程度影响,并评估与滋养血管关系。结果不同压力、时间及周期球囊扩张术后3 d均能明显改善患者ABI指数、狭窄程度及血流动力学,差异有统计学意义(P<0.05);但术后3个月ABI指数、狭窄程度及血流动力学均较术后3 d明显降低(P<0.05),而组间比较无显著差异(P>0.05)。且与术前、术后动脉外膜滋养血管增生情况相一致。结论球囊扩张可导致动脉内膜显著增厚,动脉外膜VV显著增生,并且当球囊扩张压力超过一定程度,增生的强度与球囊扩张的压力、时间和周期无显著相关性。Objective To explore the relationship between arterial revascularization and arterial restenosis after balloon dilation with different pressure,time and period. Methods From January 2015 to July 2017,80 patients with arteriosclerosis obliteration of lower extremity were admitted,and Preoperative CTA indicated that the superficial artery stenosis was more than 65%. According to different pressure,time and cycle of balloon expansion,these 80 patients were divided into four groups： group Ⅰ（ n = 20） 6 atm,2 min × 1; group Ⅱ （ n = 20） 10 atm,2 min × 1;group Ⅲ（ n = 20） 6 atm,4 min × 1; group Ⅳ（ n = 20） 6 atm,2 min × 2 times,interval 5 min. The ankle brachial index（ ABI）,doppler ultrasound and contrast-enhanced ultrasound examination were carried out at preoperative,postoperative three days and postoperative three months to evaluate the effect of different balloon dilation pressure,time and cycle on ABI,arterial stenosis,and hemodynamic improvement,and to evaluate the relationship with Vasa Vasorum. Results The ABI index,stenosis degree and hemodynamics were significantly improved after 3 days of different pressure,time and cycle balloon dilation,and the difference was statistically significant（ P〈0. 05）. However,the postoperative three months was significantly lower than 3 days after surgery（ P〈0. 05）,while there was no difference between the groups. And it was consistent with preoperative and postoperative arterial extravasation. Conclusion Balloon expansion may be leading to the marked thickening of the arterial intima,arterial outer membrane VV hyperplasia significantly,and when the balloon expansion pressure exceeds a certain degree,the strength of the hyperplasia and balloon expansion pressure,time and cycle had no significant correlation.

关 键 词：动脉粥样硬化 球囊扩张 动脉再狭窄 外膜滋养血管 

分 类 号：R543.5[医药卫生—心血管疾病]