反转导丝技术处理极度成角冠脉分叉病变的临床分析  

Clinical analysis of reversed guidewire technique in the treatment of extremely angled coronary bifurcation lesions

作　　者：苏永才[1] 张小乐[1] 黄志锋[1] 冯新武[1] SU Yong-cai;ZHANG Xiao-le;HUANG Zhi-feng;FENG Xin-wu(Department of Cardiology,First People′s Hospital of Zhaoqing City,Zhaoqing,Guangdong,526021,China)

机构地区：[1]肇庆市第一人民医院心内科,广东肇庆526021

出　　处：《心血管康复医学杂志》2020年第6期690-694,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:对比正向导丝技术,评价反转导丝技术在极度成角的冠状动脉分叉病变介入治疗中的有效性和安全性。方法:选择在我院行经皮冠状动脉介入(PCI)治疗的冠脉极度成角分叉病变患者146例,根据PCI中导丝的操作方法,分为反转导丝组(93例)和正向导丝组(53例),反转导丝组又分为无微导管组(47例)及有微导管组(46例)。观察并比较各组导丝通过病变时X线暴露时间和造影剂用量、导丝通过成功率、住院期间主要心血管不良事件(MACE)发生率。结果:与正向导丝组比较,反转导丝组导丝通过成功率显著提高(88.68%比100%),导丝通过病变时X线暴露时间[(154.53±78.88)s比(34.17±7.17)s]和造影剂用量[(17.87±4.26)ml比(7.28±2.19)ml]均显著减少,住院期间MACE发生率(7.55%比0%)显著降低,P<0.05或<0.01。与无微导管组比较,有微导管组导丝通过病变时X线暴露时间[(35.87±8.36)s比(32.43±5.24)s]及造影剂用量[(8.13±2.27)ml比(6.41±1.75)ml]均显著减少(P=0.020、0.001)。结论:处理极度成角的分叉病变时,采用反转导丝技术,尤其是在微导管辅助下患者获益更大。Objective:To assess effectiveness and safety of reversed guidewire technique(RGT)in treatment of extremely angled coronary bifurcation lesions(EACBL)comparing with forward guidewire technique(FGT).Methods:According to operation method of guidewire during PCI,a total of 146 EACBL patients undergoing PCI in our hospital were divided into reversed guidewire(RG)group(n=93)and forward guidewire(FG)group(n=53),and RG group was further divided into no micro catheter(NMC)group(n=47)and micro catheter(MC)group(n=46).Time of X-ray exposure,dosage of contrast when guidewire passed lesion,success rate of guidewire pass,and major adverse cardiovascular events(MACE)during hospitalization were observed and compared among above groups.Results:Compared with FG group,there was significant rise in success rate of guidewire pass(88.68%vs.100%),and significant reductions in time of X-ray exposure[(154.53±78.88)s vs.(34.17±7.17)s],dosage of contrast[(17.87±4.26)ml vs.(7.28±2.19)ml]when guidewire passed lesion,and MACE(7.55%vs.0%)during hospitalization in RG group,P<0.05 or<0.01.Compared with NMC group,there were significant reductions in time of X-ray exposure[(35.87±8.36)s vs.(32.43±5.24)s]and dosage of contrast[(8.13±2.27)ml vs.(6.41±1.75)ml]when guidewire passed lesion in MC group,P=0.020,0.001.Conclusion:When dealing with extremely angled coronary bifurcation lesions,reversed guidewire technique is benefits patients more when assisted by micro catheter.

关 键 词：冠心病 血管成形术 气囊 冠状动脉 导管插入术 

分 类 号：R541.4[医药卫生—心血管疾病]