拘禁球囊技术在冠心病介入治疗分叉病变分支保护中的即刻及近期临床疗效观察

The immediate and short-term clinical effect of jailed balloon technique in bifurcation lesions side branch protection of PCI

目的旨在研究观察拘禁球囊技术在冠心病介入治疗分叉病变分支保护中的即刻及近期临床疗效,为分叉病变的处理及治疗提供一种更为简单有效的策略和临床理论依据。方法将在我院接受冠状动脉造影证实为冠心病分叉病变,并接受PCI治疗的74例患者,随机分为两组:球囊对吻组(36例);拘禁球囊组(38例),通过观察:(1)接受PCI治疗时患者的临床症状(胸痛有无出现、心电图有无相关导联ST段的抬高、血流动力学有无改变,满足其中一项即可),术后肌钙蛋白及心肌酶谱的改变;(2)接受主支PCI后,分支有无闭塞或夹层,最终的冠状动脉血流TIMI分级;(3)手术耗材、曝光时间以及造影剂用量;(4)接受PCI后6个月内不良心血管事件(MACE);(5)冠状动脉造影定量分析(QCA)。两组进行统计学分析,从而对其有效性及安全性进行评价。结果球囊对吻组例发生3例分支闭塞或夹层,拘禁球囊组例发生2例分支闭塞或夹层,两组组间比较无显著性差异(P>0.05)。术后6个月,两组间边支血管开口狭窄程度无显著性差异(P>0.05),两组间MACE事件发生率和主支血管再狭窄率差异无显著性(P>0.05)。但拘禁球囊技术组节省了手术耗材,而且缩短了手术曝光时间及造影剂用量(P<0.05)。结论拘禁球囊技术简化了手术操作步骤,减少了手术并发症、曝光时间、造影剂用量及节省了手术耗材,在即刻及近期随访中疗效不劣于经典球囊对吻技术,在处理冠状动脉分叉病变中安全有效。

Objective Study the immediate and short-term clinical effect of jailed balloon technique in bifurcation lesions side branch protection of PCI,in order to provide a more simple and effective strategy and clinical theoretical evidence for handling and treating bifurcation lesions. Methods 74 patients with coronary angiography coronary bifurcation lesions and receiving PCI were randomly divided into two groups：kissing balloon group （36 patients）,jailed balloon group（38 patients）,by observing：⑴the clinical symptoms of the patients received PCI treatment（chest pain or ECG of ST segment elevation or hemodynamics）,and the changes of cardiac troponin and myocardial enzyme after PCI; ⑵arterial occlusion or dissection after accepting the main branch of PCI,and the final TIMI flow grade of coronary artery;⑶the surgical consumables,exposure time,and amount of contrast agent;⑷the major adverse cardiac events （MACE） after receiving PCI within 6 months; ⑸quantitative coronary angiography （QCA）. The two groups were statistically analyzed,thus to evaluate the safety and efficacy. Results 3 patients of jailed balloon group and 2 patients of kissing balloon group,occurred arterial occlusion or dissection,and there is no significant difference between the two groups （P〉0. 05）. After receiving PCI within 6 months,the degree of side branch vessel opening stenosis,as same as the MACE event occur-rence rate and main vessel restenosis rate,had no significant difference between the two groups （P〉0.05）. Compared with kissing balloon group,jailed balloon group not only saves surgical consumables,but also shortens exposure time and reduces the amount of contrast agent （P〈0.05）. Conclusion Jailed balloon technique simplifies the operation steps,reduces the operation complications, exposure time and amount of contrast agent,and also saves surgical consumables. Therefore,the immediate and short-term clinical effect of jailed balloon technique is not inferior to the classical kissing balloon technique,and it is a safe and effective technique in treating bifurcation lesions.