心肌血流储备分数检测靶血管病变在冠状动脉临界病变治疗中的价值  

Clinical value of FFR in guiding the treatment of coronary intermediate lesion by detecting target vessel lesions

作　　者：吴军[1] 徐大文[1] 文亚红[1] WU Jun;XU Da-wen;WEN Ya-hong(Department of Cardiology,Panzhihua Municipal Central Hospital,Panzhihua,Sichuan 617067,China)

机构地区：[1]攀枝花市中心医院心内科

出　　处：《实用医药杂志》2019年第8期689-692,699,共5页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨心肌血流储备分数(FFR)检测靶血管病变指导冠状动脉临界病变患者治疗的临床价值。方法选取2016年8月—2018年9月在笔者所在医院行冠状动脉造影证实为冠状动脉临界病变且病变血管参考直径大于2.5 mm的50例心绞痛患者作为研究对象,采用随机数字表法将其分为FFR组(22例)和非FFR组(28例),两组均根据冠状动脉病变解剖特点、临床症状等综合评估,其中FFR组行FFR检测靶血管病变,根据FFR值进行评估,非FFR组未行FFR检测靶血管病变,选择经皮冠状动脉介入治疗(PCI)联合药物治疗或单纯药物保守治疗。术中观察和记录手术成功率、并发症和不良反应,术后1、3、6个月随访观察心绞痛改善情况。结果(1)50例患者中共72处冠状动脉临界病变,其中FFR组35处,非FFR组37处,两组血管腔狭窄率比较差异无统计学意义(P>0.05);(2)术中快速静脉滴注三磷腺苷二钠注射液过程中,发生胸闷心悸的有14例,其中12例可耐受,持续至给药结束即好转;其中伴有面红者7例,3例无法耐受胸闷心悸而停药,停药后上述症状约7~8 min;(3)两组治疗后心绞痛CCS分级均较治疗前明显降低(P<0.05);(4)两组治疗后心绞痛缓解率比较,差异无统计学意义(P>0.05)。结论 FFR检测靶血管病变具有简便、安全等优点,但不能轻视快速静脉滴注三磷腺苷二钠注射液时可能发生的胸闷、心悸等不良反应,做好相关应对措施。Objective To investigate the value of fractional flow reserve (FFR) in guiding the treatment of coronary intermediate lesion by detecting target vessel lesions. Methods The 50 patients with angina confirmed as critical coronary lesions by coronary angiography from August 2016 to September 2018 in author's hospital were selected and whose reference diameter of the diseased vessels was greater than 2.5 mm,were divided into FFR group (22 cases) and non FFR group (28 cases) by random number table. In group FFR,FFR was used to detect target vessel lesions,while non FFR group did not have this detection. Except for according to the anatomic characteristics and clinical symptom,in FFR group it needs by FFR value to decide whether treat with the percutaneous coronary intervention(PCI) combined with drug therapy or pure medication conservative treatment. The intraoperative situations,surgical success rate,complications and adverse reactions were recorded. The improvement of angina was observed during the postoperative 1mon,3mon,6mon follow-up. Results 1) There were 72 coronary artery lesions in the 50 patients,including 35 lesions in FFR group and 37 lesions in non-FFR group. No significant difference was found in stenosis rate between the two groups(P>0.05);2) In the process of rapid intravenous infusion of adenosine disodium triphosphate,there were 14 cases of chest tightness and heart palpitations,of which 12 cases were tolerable and the symptoms continued until the end of administration,7 of them had facial flushing,and 3 cases couldn’t tolerate with these,so the infusion was stopped their symptoms lasted 7-8min after drug withdrawal;3) The angina CCS grade after treatment was significantly different from that before treatment(P<0.05);4)The remission rate of angina after treatment between the two groups had no difference(P>0.05). Conclusion FFR has the advantages such as simple and safe detection of target vascular lesions. It cannot underestimate the adverse reactions such as chest tightness,palpitations and other

关 键 词：心肌血流储备分数 靶血管病变 冠状动脉临界病变 临床价值 

分 类 号：R541.4[医药卫生—心血管疾病]