血管内超声在冠心病诊断中的应用观察

Study on the value of intravascular ultrasound(IVUS) in diagnosis and treatment of patients with coronary artery disease(CAD)

目的探讨血管内超声(IVUS)在冠心病诊断中的应用。方法心绞痛患者冠状动脉造影,狭窄小于70%时进行IVUS检查;根据IVUS检查的结果分为手术组(狭窄>50%)和药物组(狭窄<50%)。同时收集病人的临床资料。结果手术组(n=31)病变主要为脂质斑块(39%)和纤维及混合型斑块(42%),药物组(n=26)病变主要为钙化斑块(59%),狭窄面积没有明显的差异。结论冠脉造影明显低估冠状动脉病变的程度,手术组和药物组的主要症状A和B,心电图改变A和B存在明显的差异,证实临床病史和心电图(24h动态心电图、负荷试验)在冠心病中的诊断价值。

Objective To appraise the value of intravascular ultrasound（IVUS） in diagnosis and treatment of patients with coronary artery disease（CAD）. Methods Coronary angiography（CAG） was performed in all patients with angina, and IVUS when CAG shows insignificant stenosis （ stenosis 〈70% ）. Based on the results of IVUS ,the patients were divided into two groups of Operation and Medicine, collected their clinical data in the meanwhile. Results In 31 patients（ 31/57 ）, IVUS showed significant stenosis（ stenasis 〉 50% ） and various kinds of atheromatous plagues. The group of operation presented with more lipidic plagues（ 39% ）, fibrous and calcified plagues（ 42% ）, the group of medicine presented with more calcifed plagues（59% ）. The difference of stenotic area betweem two groups is no obvous. Conclusion GAG significantly underestimates the degree of vascular lessions. The difference of major symptom（ A or B） and change of EGG（ A or B） is clear. It is convinced the value of case history and EGG（ especially 24hours ECG and load -test）.