联合介入诊疗技术在心血管内科的应用

Application of combined interventional procedure in composite cardiovascular diseases

目的评价联合介入诊疗技术在心血管内科应用的可行性及临床效果。方法连续住院的21例拟诊为两种或两种以上心血管病(称为复合心血管病)的患者,经术前讨论拟定个体化联合介入方案,制定手术成功标准、手术并发症及不良反应防治预案,观察手术成功率、近远期临床效果、并发症及不良反应。结果接受2项联合介入诊疗手术的患者20例;接受3项联合介入诊疗手术患者1例。1次手术成功率90.5%,1例穿刺部位血肿。近期手术效果15例患者的术前症状和/或心律失常消失,4例症状减轻;1例合并频发室性早搏和1例阵发性心房颤动患者术后12h心律失常复发。远期效果随访期内2例心绞痛复发,1例冠状动脉造影证实支架内再狭窄并再次接受经皮腔内冠状动脉成形术(PTCA)+冠状动脉内支架术,无心源性死亡病例。结论在手术设备和术者技术、经验具备的心脏中心可谨慎开展联合介入诊疗手术。联合介入手术成功率与单项介入手术相似,并不增加手术并发症,近、远期临床效果满意。

Objective To evaluate the feasibility, and clinical efficacy of combined interventional procedure （CIP） in composite cardiovascular diseases （CCD）. Methods Twenty one consecutive patients were diagnosed as CCD before the procedures. The algorithm of CIP were individualized by the operators and physicians. The criteria for a successful procedure were defined before the operation. The counterplan for predictable complications was also established beforehand. The successful rate, short and long term efficacy, the incidence of complications and adverse reaction associated with contrast medium and X-ray were observed. All the patients were followed up through special out-patient clinic, telephone, or letters. Results Seven cases accepted electrophysiologlcal testing（EFT） ＋ radiofrequency catheter ablation （RFCA） ＋ coronary angiogram （CAG） ＋ percutaneous transluminal coronary angioplasty （PICA） ＋ stent implantation （ SI）. Four cases accepted CAG ＋ ＋ SI ＋ EFT. Three cases accepted EFF ＋ RFCA ＋ CAG. Six cases accepted CAG ＋ PTCA ＋ SI ＋ peripheral artery angiogram （PAG）. One cases accepted pacemaker implantation （PI） ＋ CAG ＋ FFCA ＋ SI ＋ percutaneous transluminal septal myocardial ablation （PTSMA）. The symptoms of arrhythmia disappeared or alleviater in 19 cases during hospiatalization. Arrhythmia recurred in 2 cases 12 hours after the procedure and accepted RFCA again. No severe complications and adverse reaction occured. The successful rate was 90.5 percent. Two cases suffered from recurrent angina during the follow-up period and one of them had in-stent restenosis proved by CAG and accepted TPCA ＋ SI again. The other patient received medicine therapy. Conclusion Combined interventional procedure operated by experienced interventional cardiologist in a conditioned catheterization laboratory is safe and feasible. The short-term outcomes are satisfied. The long-term outcomes will be proved by accumlating more cases＇ data. Individualized approaches, counterplans for complications and cautious operation are important to a successful procedure.