血管内超声技术在介入治疗左主干病变中的应用价值

Value of intravascular ultrasound in the interventional therapy of left main coronary stenosis

目的评价血管内超声显像（IVUS）在介入治疗左主干病变中的应用价值。方法对左主干病变63例患者进行IVUS检查，根据IVUS面积狭窄率进行分组，IVUS面积狭窄率≥50％为介入治疗组（33例）及IVUS面积狭窄率〈50％为对照组（30例）。介入治疗组采取介入干预治疗；对照组采取常规药物治疗。观察IVUS面积狭窄率及斑块的特征，并进行随访观察并发症。结果介入治疗组斑块性状以软斑块及偏心性斑块为主，介入治疗中无明显的并发症，随访1年，介入治疗组再发心绞痛4例（12．1％）。对照组发生再发心脏事件18例（60．0％），其中发生心绞痛6例，阵发性室速5例，急性心肌梗死3例（均行IVUS，显示左主干为罪犯血管），频发室性期前收缩3例，猝死l例。2组患者心脏事件发生率比较差异有统计学意义（X^213．81，P〈0．01）。结论IVUS对左主干的狭窄程度及指导介入治疗有一定的价值，对IVUS面积狭窄率≥50％的病变进行介入治疗预后良好。

Objective To evaluate the clinical application value of intravascular ultrasound（IVUS） in the treatment of left main coronary stenosis. Methods Sixty-three patients with left main coronary stenosis were identified by IVUS to evaluate the plaque characteristics and the severity of the stenosis. According to the severity of the stenosis, the patients were divided into perentaneous coronary intervention （PCI） group （ IVUS ≥50% ） （ n = 33 ） and control group （ IVUS 〈 50% ） （ n = 30 ）. The group of PCI was treated by PCI. The control group was treated by routine therapeutic agents. The profiles of plaques and stenosis were described. The complications were recorded by follow-up visits. Results More soft＇and eccentric plaques were found in PCI group. After one year follow up,cardiac events （angina） occurred in 4 cases （ 12.1% ） in PCI group. In control group, cardiac events ocurred in 18 patients （ 60. 0% ）, including 6 cases of angina, 5 case of paroxysmal ventricular tachycardia ,3 cases of myocardial infarction （confirmed by IVUS, showing that the left main coronary artery was responsible for the event）, 3 cases of frequent premature ventricular contraction and 1 ease of sudden death. There was a significant difference in the occurrence rate of cardiac events between PCI group and non-PCI group （ X^2 = 13.81, P 〈 0.01 ）. Conclusion IVUS is useful for the identification and treatment guidance. Intervention therapy produces good prognosis in patients with IVUS-identified left main coronary stenosis by more than 50% of the area.