单支架处置冠状动脉分叉病变时不同策略的临床研究  

Clinical study of different strategies for single stent in the treatment of coronary bifurcation lesions

作　　者：冼展超[1] 杨大浩 曾繁芳[1] 王小庆[1] 廖志勇[1] 闫少迪[1] XIAN Zhan-chao;YANG Da-hao;ZENG Fan-fang;WANG Xiao-qing;LIAO Zhi-yong;YAN Shao-di(No. 1 Department of Cardiology,Shenzhen Sun Yat-sen Cardiovascular Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]深圳市孙逸仙心血管医院心内科一区

出　　处：《岭南心血管病杂志》2019年第4期371-375,384,共6页South China Journal of Cardiovascular Diseases

基　　金：深圳市科技计划(项目编号:JCYJ20160427174117767)

摘　　要：目的探讨"拘禁"球囊技术(Jailed balloon technique,JBT)、边支导丝保护(keep it open,KIO)技术以及无边支保护技术在冠状动脉分叉病变治疗中的应用效果.方法回顾性选取2016年1月至2017年3月深圳市孙逸仙心血管医院收治的162例冠状动脉分叉病变行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的患者,根据治疗方法分成3组,采用JBT组58例,采用KIO技术治疗组59例,采用无边支保护技术治疗者45例(无边支保护组),比较3组患者对比剂用量、手术时间、放射线曝光时间、PCI治疗后即刻影像学效果及30 d主要不良心血管事件(major adverse cardiovascular event,MACE)发生率等方面差异.结果JBT组患者无边支丢失发生,KIO组及无边支保护组患者各有1例发生边支丢失.JBT组手术时间及放射线曝光时间、对比剂用量均较KIO组及无边支保护组低,差异有统计学意义(P<0.05).术后随访12个月,JBT组MACE总体发生率为12.07%,低于KIO组的27.12%和无边支保护组的33.33%,差异有统计学意义(P<0.05).JBT组主支血管最大狭窄程度为18.21%±4.40%,低于KIO组的22.34%±5.17%和无边支保护组的23.45%±5.09%,差异有统计学意义(P<0.05).JBT组边支血管开口狭窄程度为48.33%±4.60%,低于KIO组的70.41%±8.53%和无边支保护组的75.62%±7.44%,差异有统计学意义(P<0.05).3组间主支血管再狭窄率比较,差异无统计学意义(P>0.05).结论JBT处置冠状动脉分叉病变具有并发症少、安全性高的特点,且术后随访表明其对边支血管开口狭窄程度影响小且患者的MACE发生率低,值得临床推广和应用.Objectives To investigate the effect of Jailed balloon technique(JBT),keep it open(KIO)technique and non-marginal branch protection technique in the treatment of coronary bifurcation lesions.Methods From January 2016 to March 2017,clinical data of 162 patients with coronary bifurcation lesions performed percutaneous coronary intervention(PCI)in Shenzhen Sun Yat-sen Cardiovascular Hospital were retrospectively analyzed.They were divided into 3 groups according to different treatment methods.The 58 patients treated with JBT were in JBT group,the 59 patients treated with KIO technique were in KIO group and the 45 patients treated with non-marginal branch protection technique were in nonmarginal branch protection technique group.The dosage of contrast agent,duration of operation,duration of radiation exposure,immediate imaging effect after PCI and the incidence of major adverse cardiovascular events(MACE)in 30 days were compared among the 3 groups.Results There was no marginal branch in JBT group,cohile there was one mar-ginal branch occured in KIO group and non-marginal branch protection technique group respectively The duration of operation,duration of exposure and dosage of contrast agent in JBT group were lower than those in KIO group and non-marginal branch protection technique group(P<0.05).After 12 months follow-up,the overall incidence of MACE in JBT group was 12.07%,which was lower than 27.12%in KIO group and 33.33%in non-marginal branch protection technique group,and the difference was significant(P<0.05).The maximum stenosis degree of main branch vessels in JBT group was significantly lower than that in KIO group and non-marginal branch protection technique group(18.21%±4.40%vs.22.34%±5.17%,P<0.05;18.21%±4.40%vs.23.45%±5.09%,P<0.05).The stenosis degree of orifice in JBT group was lower than that in KIO group and non-marginal branch protection technique group,and differences among which were significant(48.33%±4.60%vs.70.41%±8.53%,P<0.05;48.33%±4.60%vs.75.62%±7.445,P<0.05).There was no significant d

关 键 词：冠状动脉疾病 “拘禁”球囊技术 边支导丝保护技术 无边支保护技术 

分 类 号：R541.4[医药卫生—心血管疾病]