血管内超声技术在介入治疗急性冠脉综合征中的应用研究

Exploratory development of intravascular ultrasound in interventional therapy for acute coronary syndrome

目的探讨血管内超声（IVUS）在介入治疗急性冠脉综合征（ACS）中的临床价值。方法65例ACS患者，35例在IVUS指导下实施支架置入术为治疗组，30例直接支架置入术患者为对照组，术后随访1年，观察两组患者心绞痛等心血管不良事件发生率。结果治疗组支架置入后IVUS检查，3例贴壁欠佳，7例支架未充分扩张，使用高压球囊高压扩张（18-20atm）后复查IVUS达到满意标准，其余25例达到满意标准；支架置入后，斑块面积显著减少（P〈0．01），病变处最小管腔面积、最小管腔直径显著增加（P〈0．01）。对照组30例支架置入后，CAG提示贴壁良好，TIMI血流3级。随访1年，治疗组1例出现心绞痛，3例偶发性室性早搏；对照组6例出现心绞痛，4例频发室性早搏，5例出现劳力性胸闷。结论IVUS能准确测量血管直径、病变处血管腔面积及斑块面积，同时能分析病变偏心程度及斑块特征，因此可指导选择支架的规格，支架置入后可观察支架的位置、比邻关系、贴壁情况，支架扩张程度，是评价冠脉支架置人较理想的方法。

Objective To investigate the clinical value of intravascular ultrasound in interventional therapy for acute coronary syndrome. Methods The patients with acute coronary syndrome were 65 cases. The cure groups of 35 cases of the patients were treated with stand implanting by intravascular ultrasound. The control groups of 30 cases were treated with straight stand implanting. The incidence rate of cardiac events were observed in two groups for one year follow-up visit. Results The result of IVUS for the cure group was that 3 cases adher- enced below the mark, and the stands of 7 cases were expanded nulli-thoroughly. However the result was better by post-expanded under 18-20 atm. The rest of 25 cases were succeed. The area of plaque was obviously decreased （P〈0.01）, and the area of smallest lumens and the diameter of smallest lumens was obviously increased （P〈0.01） after stand implanting by intravascular ultrasound. CAG showed that the stands adherenced well and TIMI was 3 grade after the stands imbedding in the control group. 1 case occurred sternalgia and 3 case occurred abiogenesis premature ventricular contraction in the cure group; 6 case occurred sternalgia, 4 occurred frequently premature ventricular contraction and 5 case occurred chest distress. Conclusion IVUS can accur measure blood vessel di- ameter, the area of lumen of blood vessel and plaque. Meanwhile can analyze the decenter level and plaque feature, so IVUS can guidance to choose stand etalon. It can observe stand position, adherence information, expand degree. IVUS is good method for stand embedding.