冠状动脉分叉病变处于血流储备分数临界值时介入治疗策略的选择思路构架实践  

The selection of interventional treatment strategy for coronary bifurcation lesion at the critical value of fractional flow reserve

作　　者：袁超[1] YUAN Chao(Cardiology Department,Wuhan Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院心内科,430022

出　　处：《中国实用医药》2023年第16期44-47,共4页China Practical Medicine

摘　　要：目的探讨冠状动脉(冠脉)分叉病变(CBL)处于血流储备分数(FFR)临界值时经皮冠脉介入术(PCI)的治疗策略选择思路及效果。方法102例处于FFR临界值的CBL患者,根据PCI方案不同分为观察组(单支架,62例)和对照组(双支架,40例)。观察组予以单支架PCI治疗,对照组予以双支架PCI治疗。比较两组肝素用量、造影剂用量、支架总长、支架直径、手术时间、住院时间,生活质量评分,心血管不良事件发生情况。结果观察组肝素用量(6125.28±2014.21)IU、造影剂用量(162.51±50.32)ml显著少于对照组的(7432.05±2201.63)IU、(260.51±70.14)ml,支架直径(2.70±0.16)mm显著窄于对照组的(2.97±0.24)mm,支架总长(28.62±7.04)mm、手术时间(77.21±20.36)min与住院时间(2.85±0.75)d显著短于对照组的(54.31±14.03)mm、(113.25±30.54)min、(3.62±0.91)d,差异具有统计学意义(P<0.05)。术前,两组躯体功能、物质功能、心理功能、社会功能评分比较差异均无统计学意义(P>0.05);术后1个月,观察组躯体功能、物质功能、心理功能、社会功能评分分别为(84.16±2.33)、(84.29±2.33)、(84.84±2.38)、(84.33±2.67)分,均高于对照组的(78.26±2.72)、(78.33±2.77)、(78.44±2.73)、(78.54±2.13)分,差异具有统计学意义(P<0.05)。随访1年,两组心肌梗死、冠脉再狭窄、血管重建、心绞痛再入院、死亡发生率比较,差异均无统计学意义(P>0.05)。结论处于FFR临界值的CBL患者采取单支架与双支架PCI治疗,心血管不良事件发生率无明显差异,但单支架PCI治疗的肝素用量、造影剂用量更少,支架总长更短,支架直径更窄,手术时间与住院时间更少,而且可更好地改善术后生活质量,值得应用。Objective To discuss the therapeutic strategies and effects of percutaneous coronary intervention(PCI)for coronary bifurcation lesion(CBL)at the critical value of fractional flow reserve(FFR).Methods A total of 102 patients with CBL at the critical value of FFR were divided into observation group(one stent,62 cases)and control group(double stent,40 cases)according to different PCI protocols.The observation group was treated with single-stent PCI,and the control group was treated with double-stent PCI.The heparin dosage,contrast agent dosage,total stent length,stent diameter,operative time,hospital stay,quality of life score,and adverse cardiovascular events were compared between the two groups.Results The heparin dosage of(6125.28±2014.21)IU and contrast agent dosage of(162.51±50.32)ml in the observation group were significantly lower than those of(7432.05±2201.63)IU and(260.51±70.14)ml in the control group;the stent diameter of(2.70±0.16)mm in the observation group was significantly narrower than that of(2.97±0.24)mm in the control group;the observation group had total stent length of(28.62±7.04)mm,operative time of(77.21±20.36)min,and hospital stay of(2.85±0.75)d,which were significantly shorter than those of(54.31±14.03)mm,(113.25±30.54)min,and(3.62±0.91)d in the control group;the differences were statistically significant(P<0.05).Before surgery,there were no statistically significant differences in the scores of physical function,material function,psychological function and social function between the two groups(P>0.05).1 month after surgery,the scores of physical function,material function,psychological function and social function were(84.16±2.33),(84.29±2.33),(84.84±2.38)and(84.33±2.67)points in the observation group,which were higher than those of(78.26±2.72),(78.33±2.77),(78.44±2.73)and(78.54±2.13)points in the control group,and the differences were statistically significant(P<0.05).After 1 year of follow-up,there were no statistically significant differences in the incidence of myoca

关 键 词：冠状动脉分叉病变 血流储备分数 经皮冠状动脉介入术 单支架 双支架 生活质量 心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]