磁导航引导下以少量对比剂完成冠状动脉介入治疗

Percutaneous coronary intervention with little contrast guided with magnetic navigation system

目的探索利用磁导航技术辅助冠脉介入操作以减少对比剂用量。方法冠脉造影至少有1支血管病变需要支架治疗的病人31例(男24例),平均年龄(66.7±10.6)岁。分为3组,常规技术组、磁导航辅助组、复合技术组(以磁导航和光干涉断层成像技术结合引导支架植入)。所有病例记录操作时间、X线曝光时间、对比剂用量等参数,进行组间比较。结果在常规技术、磁导航辅助和复合技术组中,性别构成比(男性例数分别为8、9、7例)、病变部位(前降支6,5,3例;回旋支1,4,2例;右冠5,2,3例)等无显著差异;操作时间有显著差异,分别为(42.2±18.1),(58.7±23.5),(71.9±28.4)min,其中复合技术组用时最多;对比剂用量有显著性差异,分别为(76.5±12.6),(43.4±9.7),(36.3±6.2)ml,其中常规技术组用量最多。3组的X线曝光时间分别为(2.8±1.1),(2.7±0.9),(3.3±1.7)min;支架内残余狭窄率分别为(6.2±3.1),(6.6±4.9),(7.1±4.1)%;主要心脏病事件发生率各组均为0,3组比较,这些参数无显著差异。结论磁导航技术应用于冠脉介入领域可以明显降低对比剂用量;虽然操作时间有延长,但X线曝光时间无明显增加。

Objective To research a method to reduce the dosage of contrast in the process of percutaneous coronary intervention. Methods Thirty one patients with at least one lesion were divided into routine technique group （12 patients,RT group）,magnetic navigation system（MNS） assistant group （11 patients,MA group） and multiple technique group （11 patients,MT group）. Parameters including procedure time,X ray exposure time,dosage of contrast were recorded in all cases. Results Among three groups （RT,MA and MT group）,there were no significant differences in gender and lesion location.. The time of procedure had significant difference among RT,MA and MT groups,（42.2±18.1）,（58.7±23.5）,（71.9±28.4）min respectively,MT group needed the longest time. The dosage of contrast had significant difference among the 3 groups,（76.5±12.6）,（43.4±9.7）,（36.3±6.2）ml respectively,RT group used the highest dose of contrast. X ray exposure time,the incidence of major adverse cardiac events and the residual stenosis ratio had no significant difference among the 3 groups.Conclusion The dosage of contrast can be reduced markedly in the procedure assisted with MNS and optical coherence tomography. Though the procedure time was prolonged in MT group,X ray exposure time had no difference among 3 groups.