IVUS引导下Step-Crush术治疗左主干分叉病变对支架贴壁情况及患者预后的影响  

Effect of IVUS-guided Step-Crush Surgery on Stent Adhesion Situation and Prognosis of Patients with Left Main Bifurcation Disease

作　　者：曾紫微[1] 许滔 周竹花 熊健[1] 殷锡虎 刘继文[1] 王新旺[1] ZENG Ziwei;XU Tao;ZHOU Zhuhua;XIONG Jian;YIN Xihu;LIU Jiwen;WANG Xinwang(General Hospital of Jiujiang NO.1 People's Hospital,Jiangxi Province,Jiujiang 332000,China;不详)

机构地区：[1]江西省九江市第一人民医院总院,江西九江332000 [2]贵州中医药大学第二附属医院

出　　处：《中国医学创新》2023年第36期42-46,共5页Medical Innovation of China

基　　金：江西省中医药管理局科技计划项目(2022B007)。

摘　　要：目的:分析血管内超声(IVUS)引导下Step-Crush术治疗左主干分叉病变对支架贴壁情况及患者预后的影响。方法:回顾分析2021年3月—2022年12月于九江市第一人民医院总院心血管内科就诊的左主干分叉病变患者60例,根据手术方式将患者分为IVUS组(n=34,采用IVUS引导下StepCrush术)和常规组(n=26,采用常规Step-Crush术)。对比两组支架情况(最大支架直径、左主干支架长度、支架贴壁不良发生率、支架边缘夹层发生率)、球囊参数(球囊最大直径、球囊最大压力)、心功能指标[左室射血分数(LVEF)、左室舒张末内径(LVEDD)]及心血管不良事件发生率。结果:相较于常规组,IVUS组最大支架直径、左主干支架长度、球囊最大直径均更长,球囊最大压力更大(P<0.05);术后2个月,IVUS组LVEF较常规组更高,LVEDD较常规组更低,差异均有统计学意义(P<0.05);IVUS组支架贴壁不良发生率、心血管不良事件发生率均更低,差异均有统计学意义(P<0.05)。两组支架边缘夹层发生率对比,差异无统计学意义(P>0.05)。结论:IVUS应用于Step-Crush术中可改善左主干分叉病变患者支架置入情况,降低支架贴壁发生率,有效预防心血管不良事件发生。Objective:To analyze the effect of IVUS(intravascular ultra sound)-guided Step-Crush surgery on stent adhesion situation and prognosis of patients with left main bifurcation disease.Method:A total of 60patients with left main bifurcation disease who were admitted to the Cardiovascular Department of General Hospital of Jiujiang NO.1 People's Hospital from March 2021 to December 2022 were retrospectively analyzed,and they were divided into IVUS(n=34,treated with IVUS-guided Step-Crush surgery)and conventional group(n=26,treated with conventional Step-Crush surgery)according to the surgical methods.The stent situation(maximum stent diameter,left main stent length,stent adhesion defect rate,stent edge sandwich rate),balloon parameters(maximum balloon diameter,maximum balloon pressure),cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]and the incidence of cardiovascular adverse events were compared between the two groups.Result:Compared with the conventional group,the maximum stent diameter,the left main stent length and the maximum balloon diameter in IVUS group were longer,and the maximum balloon pressure in IVUS group was higher(P<0.05).2 months after surgery,LVEF in IVUS group was higher than that in conventional group,and LVEDD in IVUS group was lower than that in conventional group,the differences were statistically significant(P<0.05).The incidence of stent adhesion defect and the incidence of cardiovascular adverse events were lower than those in conventional group,the differences were statistically significant(P<0.05).There was no significant difference in the stent edge sandwich incidence between the two groups(P>0.05).Conclusion:The application of IVUS in Step-Crush surgery can improve stent placement situation in patients with left main bifurcation disease,reduce the incidence of stent adherence,and effectively prevent cardiovascular adverse events.

关 键 词：血管内超声 Step-Crush术 左主干分叉病变 支架贴壁 

分 类 号：R541.4[医药卫生—心血管疾病]