直接冠脉支架植入术在冠心病并左心功能不全中的应用

Direct stenting in coronary artery disease patients with severe ventricular dysfunction

目的 :评价直接冠脉支架植入术在冠心病左心功能不全应用的安全性和疗效。方法 :189名冠心病左心功能不全患者随机分成未预扩直接植入支架术 ( 组 ,n=95 )和预扩后植入支架术 ( 组 ,n=94)两组 ,观察两组 X线暴光时间、手术时间、造影剂用量、手术费用和心功能情况 ,左心功能通过 NYHA分级和超声心动图 (UCG)评价。结果 : 组 X线暴光时间、手术时间、造影剂用量、球囊导管用量 (分别是 10± 5 min,2 1± 5 min,93± 10 m l,2根 )均低于 组 (分别是 15± 2 m in,41± 10 min,136± 2 3ml,94根 ) ,4项数据两组间均有显著性差异 (P<0 .0 5 ) ;围手术期心功能恶化者 组 (2例 )明显低于 组 (2 5例 ) ,P <0 .0 5 ;U CG测左室射血分数 (L VEF)和左心室内径(L VID) : 组术前 L VEF为 (4 1± 10 ) % ,术后 3月为 (5 4± 12 ) % ,P<0 .0 5 ,L VID术前 5 9± 5 m m,术后 3个月为5 2± 5 m m ,P<0 .0 5 ; 组术前 L VEF为 (4 0± 11) % ,术后 3月为 (5 2± 10 ) % ,P<0 .0 5 ,L VID术前 5 9± 5 m m ,术后 3月为 5 3± 6 mm ,P<0 .0 5 ;术后 3个月 L VEF和 L VID 组和 组无明显差异。结论 :直接支架术改善冠心病左心功能不全较预扩支架术疗效明显 ,且减少手术时间、造影剂用量及手术费用 。

AIM: To evaluate the safety and feasibility of direct stent implantation in coronary artery disease with severe ventricular dysfunction. METHODS: 189 cases with severe ventricular dysfunction were divided into two groups who underwent stenting without (groupⅠ, n=95) and with (groupⅡ, n=94) predilation. The differences between the two groups in radiation exposure time, procedure time,the amount of dye, cost and heart function were assessed . The heart function was determined by NYHA functional class and LVEF tested by UCG. RESULTS: The radiation exposure time, procedure time, amount of dye and balloon were lower in groupⅠ than those in group Ⅱ(P<0.05). There were more patients whose heart function worsened during perioperation in groupⅡ(25 case) than in groupⅠ(2 case), P<0.05. LVEF values before and 3 months after the operation were (41±10)% and (54±12)% in groupⅠ( P<0.05),and (41±11)% and (52±10)% in group Ⅱ respectively (P<0.05); LVID values before and 3 months after the operation were 59±5 mm and 52±5 mm ( P<0.05) in groupⅠ,and 59±5 mm and 53±6 mm ( P<0.05) in groupⅡ respectively. There was no difference in LVEF and LVID between the two groups 3 months after the operation. CONCLUSION: In coronary heart disease patients with severe ventricular dysfunction, direct stenting without balloon predilation can improve their heart function more significantly than predilation. This technique reduced radiation exposure time, procedure time, and the amount of dye and balloon, and was safe and feasible.