血管内超声在经皮冠状动脉介入治疗中的应用价值

Significance of intravascular ultrasound in the percutaneous coronary intervention

目的探讨血管内超声在不稳定心绞痛患者进行介入手术时的应用价值。方法选择52例需行介入治疗的不稳定心绞痛患者,随机分为经血管内超声指导的介入治疗组和经常规冠状动脉造影指导的介入治疗组。观察两组患者手术成功率、选择支架的直径及个数、支架扩张时最大球囊压力、管腔直径的急性获得值、支架植入后残余狭窄、最小管腔直径,并对两组患者进行了12个月的随访,观察死亡、Q波心肌梗死、因不稳定心绞痛再次住院、亚急性血栓闭塞等情况。结果经血管内超声指导组患者达到满意的介入效果,球囊压力、管腔直径的急性获得值及最小管腔直径明显高于常规治疗组[分别为(1491.77±197.96)kPa对(1317.04±180.79)kPa,P<0.01;(2.25±0.38)mm对(2.02±0.34)mm,P<0.05;(2.98±0.38)mm对(2.69±0.37)mm,P<0.01];术后靶病变血管残余狭窄率、术后12个月内因不稳定心绞痛住院率明显低于常规治疗组[分别为(4.42±6.05)%对(8.65±8.43)%,P<0.05;3.85%对23.07%,P<0.05]。结论对不稳定性心绞痛患者进行介入手术时,血管内超声指导比冠状动脉造影指导的可操作性和远期效果均好;支架内球囊压力大于1519.87kPa(15大气压)时,介入治疗效果较佳。

Objective To study the significance of intravascular ultrasound（IVUS） in patients with unstable angina pectoris undergoing percutaneous coronary intervention（PCI）. Methods Fifty-two unstable angina pectoris patients which need undergo PCI were randomized to IVUS group and conventional coronary angiography（CAG） group to observe the procedural success rate, size and number of stents used, maximum balloon inflation pressure, acute gain of target vessel, residual stenosis of instent, minimum vessel diameter and after-hospital clinical event information in each group. Results The maximum balloon inflation pressure, acute gain, minimum target vessel diameter were larger in IVUS group than those in CAG group [（1491.77 ± 197. 96）kPa vs （1317.04 ±180.79）kPa, P 〈0.01 ; （2.25 ±0.38）mm vs （2.02 ± 0.34）mm, P 〈 0.05;（2.98 ± 0.38）ram vs （2.69 ± 0.37）mm, P 〈0. 01]. The target vessel residual stenosis and rehospitalization rate due to unstable angina in IVUS group were lower than those in CAG group[（4.42 ± 6.05）% vs （8.65±8.43）%,P〈0.05;3.85% vs 23. 07% , P 〈0. 05]. Conclusions PCIguidedbylVUS can make greater advance both in procedure and in long term clinical outcome than that in CAG group. In order to get the better clinical results, higher balloon inflation pressure （beyond 1519.87 kPa） is needed during PCI.