支架增强显影技术在复杂冠状动脉病变介入治疗中的应用和疗效分析  

The effects of applying Stent Boost Subtract technique during percutaneous coronary intervention in patients with complex coronary lesions

作　　者：刘思博 刘远健 朱栋梁[2] 李韶南[2] 潘艺朝 Liu Sibo;Liu Yuanjian;Zhu Dongliang;Li Shaonan;Pan Yichao(Shenzhen SAMII Medical Center,Shenzhen 518118,China;Department of Cardiology,Guangzhou First People's Hospital,Guangzhou 510180,China)

机构地区：[1]深圳市萨米医疗中心,深圳518118 [2]广州市第一人民医院心血管内科,广州510180

出　　处：《中国医师杂志》2022年第6期902-906,共5页Journal of Chinese Physician

基　　金：广东省医学科学技术研究基金项目(201611119319867)。

摘　　要：目的探讨应用支架增强显影技术(SBS)指导经皮腔冠状动脉内介入术(PCI)治疗复杂冠状动脉病变的疗效。方法选择2018年1月至2020年1月在广州市第一人民医院心血管内科住院接受PCI治疗的冠心病(CAD)患者200例,患者冠脉造影结果均为美国心脏协会(AHA)/美国心脏病学会(ACC)冠脉病变分型定义的B2或C型病变。200例患者使用随机数字表法分为SBS组82例和血管内超声(IVUS)组118例,SBS组患者应用SBS技术指导PCI治疗,IVUS组患者应用IVUS指导PCI治疗。两组患者支架植入后采用定量冠状动脉造影(QCA)自动分析系统测量支架直径的相关参数(包括支架直径的最小值、最大值、均值)并计算支架偏心指数,记录两组患者PCI术中支架偏心指数、支架后扩张、开口病变支架定位不良、长病变串联支架未能重叠情况、平均每台PCI的辐射累积剂量(CD)、总剂量面积乘积(DAP)、透视时间、手术时间和手术费用。PCI术后对患者进行18个月的随访,记录随访期间患者不良心血管事件(MACE)发生情况,比较两组患者无MACE事件的累积生存率。结果两组患者在支架偏心指数、指导支架后扩张比例、开口病变支架定位不良比例、支架未能重叠比例等方面差异均无统计学意义[(0.12±0.04)vs(0.10±0.03);80.49%vs 85.49%;2.44%vs 2.54%;1.22%vs 2.54%,均P>0.05]。SBS组PCI手术的CD、透视时间和DAP较IVUS组差异无统计学意义[(1394.18±42.29)Gy/cm^(2) vs(1391.82±45.06)Gy/cm^(2);(18.79±3.01)min vs(18.95±3.12)min;(100.24±5.70)Gy/cm^(2) vs(99.47±5.93)Gy/cm^(2);均P>0.05]。SBS组手术时间短于IVUS组[(70.91±6.51)min vs(73.89±8.95)min,P<0.05],手术费用少于IVUS组[(2.98±0.86)万元vs(3.85±0.81)万元,P<0.05]。PCI术后随访18个月,Kaplan-Meier生存分析显示SBS组患者无MACE事件生存率与IVUS组患者相比差异无统计学意义(91.46%vs 94.07%,Log Rank=0.480,P=0.489)。结论SBS技术能便捷、快速有效地指导复杂冠状动�Objective To investigate the effects of applying Stent Boost Subtract(SBS)technique during percutaneous coronary intervention in patients with complex coronary lesions.Methods 200 patients with coronary artery disease(CAD)who hospitalized in the department of cardiology in Guangzhou First People's Hospital from June 2018 to June 2020 were enrolled.The coronary lesions of all patients were corresponding to B2 or C type suggested by American Heart Association(AHA)/American College of Cardiology(ACC)according to coronary angiography and treated with percutaneous coronary intervention(PCI).Patients were randomly divided into SBS group(n=82,SBS technique was applied during PCI)and IVUS group[n=118,intravascular ultrasound(IVUS)was applied during PCI].After stent implantation,quantitative coronary angiography(QCA)automatic analysis system was used to measure the related parameters of stent diameter(including the minimum,maximum and mean value of stent diameter)and calculate the stent eccentricity index.During PCI,stent eccentricity index,post-stent expansion,poorly positioned stent with open lesions,failure of overlapping stent with long lesions,mean cumulative dose(CD),product of total dose area(DAP),X-ray time,operation time and operation cost of each PCI were recorded in the two groups.Patients were followed up for 18 months after PCI,and the occurrence of adverse cardiovascular events(MACE)was recorded during the follow-up period,and the cumulative survival rate without MACE was compared between the two groups.Results There were no statistically significant differences between the two groups in stent eccentricity index,proportion of guided stent expansion,proportion of poorly positioned stent with open lesions,proportion of stent failure to overlap,with statistically significant difference[(0.12±0.04)vs(0.10±0.03);80.49%vs 85.49%;2.44%vs 2.54%;1.22%vs 2.54%,all P>0.05].There were no significant differences in CD,X-ray time and DAP in SBS group compared with IVUS group[(1394.18±42.29)Gy/cm^(2) vs(1391.82±45.06)G

关 键 词：冠状动脉疾病 经皮冠状动脉介入治疗 支架影像增强显影 

分 类 号：R541.4[医药卫生—心血管疾病]