漂浮导管监测下的介入治疗在高危重症冠心病患者中的应用  

Application of percutaneous coronary intervention under the monitoring of floating catheter in patients with high critical coronary heart disease

作　　者：张海凤 周梦竹 霍宁 陈砚戈 富华颖[1] 刘彤[1] 李广平[1] 刘长乐[1] Zhang Haifeng;Zhou Mengzhu;Huo Ning;Chen Yange;Fu Huaying;Liu Tong;Li Guangping;Liu Changle(Department of Cardiology,The Second Hospital of Tianjin Medical University,Tianjin 300202,China)

机构地区：[1]天津医科大学第二医院心血管内科,天津300202

出　　处：《中华心脏与心律电子杂志》2022年第4期209-214,共6页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

基　　金：天津市自然科学基金(15JCQNJC10200,21JCYBJC01460);天津市医学重点学科(专科)项目(TJYXZDXK-029A);天津医科大学第二医院重点实验室科研基金(2019ZDSYS03);天津医科大学第二医院临床专业水平提升计划(新技术)基金(2021-15)。

摘　　要：目的评估冠状动脉病变复杂高危且有介入治疗指征的患者(CHIP)经肘正中静脉入路漂浮导管监测下行经皮冠状动脉介入治疗(PCI)的可行性和安全性。方法这是一项单中心、回顾性、观察性研究。入选2020年1月至2022年6月天津医科大学第二附属医院心血管内科行PCI治疗的CHIP,术中使用经肘正中静脉漂浮导管监测的患者为观察组,同期未使用者为对照组。收集患者的性别、年龄、合并症、血脂等参数。比较两组住院期间主要不良心血管事件(MACE)发生率。观察组术前、术后进行相关压力监测,并比较术前术后肺毛细血管楔压(PCWP)、肺动脉压(PAP)、右心房压力(RAP)、右心室压力(RVP)变化。结果共入组98例患者,年龄(67.16±11.56)岁,其中女35例。观察组49例,对照组49例。两组患者年龄、性别、合并症、血脂等差异无统计学意义。与对照组相比,观察组术后住院期间MACE发生率更低[16.33%(8/49)对4.08%(2/49),P=0.045]。与术前相比,观察组术后PCWP[(22.58±7.78)mmHg对(18.25±6.93)mmHg,P=0.000]、PAP[(31.03±9.68)mmHg对(25.92±8.63)mmHg,P=0.000]、RAP[(14.26±5.80)mmHg对(12.06±5.65)mmHg,P=0.002]、RVP[(23.69±8.81)mmHg对(21.43±7.75)mmHg,P=0.021]均下降。结论CHIP-PCI常规行漂浮导管监测可精确反馈右心压力、指导治疗,保障手术顺利进行,降低围术期MACE发生率,值得临床推广。Objective To investigate the feasibility and safety of percutaneous coronary intervention(PCI)under the monitoring of floating catheterisaion via the median cubital vein in patients with complex and high-risk coronary artery disease and with indications for interventional therapy(CHIP).Methods This is a single center,retrospective,observational study.CHIP received PCI from January 2020 to June 2022 were selected from the Department of Cardiology of the Second Hospital of Tianjin Medical University.The patients under the monitoring of floating catheter via the median cubital vein were the observation group,and the non-users at the same time were the control group.The parameters of age,sex,complication,blood lipid and so on were documented.The incidence of major adverse cardiovascular events(MACE)during hospitalization were compared in the two groups.Preoperative,intraoperative and postoperative relevant pressure monitoring such as pulmonary capillary wedge pressure(PCWP),pulmonary artery pressure(PAP),right atrial pressure(RAP),right ventricular pressure(RVP)were compared in the observation group.Results A total of 98 patients were enrolled,aged(67.16±11.56)years,including 35 women.There were 49 in the observation group and 49 in the control group.There was no significant difference in age,sex,complications and blood lipid between the two groups.Compared with the control group,the observation group had a lower incidence of MACE during hospitalization after surgery[16.33%(8/49)vs.4.08%(2/49),P=0.045].Compared with pre PCI,PCWP[(22.58±7.78)mmHg vs.(18.25±6.93)mmHg,P=0.000],PAP[(31.03±9.68)mmHg vs.(25.92±8.63)mmHg,P=0.000],RAP[(14.26±5.80)mmHg vs.(12.06±5.65)mmHg,P=0.002]and RVP[(23.69±8.81)mmHg vs.(21.43±7.75)mmHg,P=0.021]decreased in the observation group after PCI.Conclusion Routine monitoring of floating catheterisation in CHIP-PCI can accurately determine right heart pressure,guide treatment,and reduce the incidence of perioperative MACE with good clinical utility.

关 键 词：冠心病 漂浮导管 经皮冠状动脉介入治疗 肘正中静脉 

分 类 号：R541.4[医药卫生—心血管疾病]