冠状动脉血管内超声在冠状动脉支架置入术中的应用价值

Application value of coronary intravascular ultrasonography in coronary heart disease and intracoronary stent implantation

目的探讨冠状动脉粥样硬化性心脏病(冠心病)冠状动脉(冠脉)血管内超声(IVUS)病变特点及IVUS在冠脉支架置入术中的应用价值。方法选取2016年5月~2017年3月于郑州大学附属洛阳中心医院就诊的68例冠心病患者,随机分为观察组与对照组,每组各34例。两组均接受IVUS检查,同时对照组经冠状动脉造影(CAG)指导实施冠脉支架置入术,观察组经IVUS指导实施冠脉支架置入术。统计分析冠脉病变IVUS检查特征、治疗前后病变血管最狭窄部位最小血管直径(MLD)、斑块负荷、直径狭窄率(DS)变化情况、支架置入率及达标率,并于1年后随访,统计对比两组心脏事件发生率。结果 IVUS检查可知68例患者中,冠脉狭窄程度>70%者占11.76%,最小管腔面积<4 mm^2者占50.00%;治疗后两组MLD较治疗前增加,斑块负荷及DS较治疗前减小,且观察组MLD高于对照组,斑块负荷及DS小于对照组(P<0.05);观察组支架置入率94.12%及达标率88.24%高于对照组(70.59%、64.71%,P<0.05);两组心血管事件发生率比较,观察组11.76%低于对照组20.58%,但差异无统计学意义(P>0.05)。结论经IVUS检查可有效检出冠心病冠脉病变特征,于其辅助下实施冠脉支架置入术效果显著,可有效增加血管直径,减小斑块负荷,提高支架置入率及达标率,降低不良心血管事件发生风险,具有推广价值。

Objective To discuss the application value of coronary intravascular ultrasonography （IVUS） in coronary artery lesions of coronary heart disease （CHD） and intracoronary stent implantation. Methods CHD patients （n=68） were chosen from the Luoyang Central Hospital affiliated to Zhengzhou University from May 2016 to Mar. 2017, and divided randomly into observation group and control group （each n=34）. Both groups were given IVUS examination, meanwhile control group was undergone intracoronary stent implantation guided by coronary angiography （CAG） and observation group, guided by IVUS. The changes of IVUS features, minimal lumen diameter （MLD） of most stenosis part of diseases vascular before and after treatment, plaque burden, rate of diameter stenosis （DS）, stent placement rate and compliance rate were analyzed in 2 groups. The incidence of cardiovascular events was followed up and compared in 2 groups after 1 y. Results The results of IVUS showed that, among 68 patients, the patients with severity of coronary artery stenosis〉70% accounted for 11.76% and those with smallest lumen area〈4 mm2 accounted for 50.00%. MLD increased, and plaque burden and DS decreased in 2 groups after treatment. MLD was higher and plaque burden and DS were lower in observation group than those in control group （P〈0.05）. The stent placement rate was 94.12% and compliance rate was 88.24% in observation group, which were all higher than those in control group （70.59%, 64.71%, P〈0.05）. The incidence of cardiovascular events was lower in observation group （11.76%） than that in control group （20.58%, P〉0.05）. Conclusion IVUS can effectively detects CHD coronary lesion features, with which assistance, intracoronary stent implantation will have significant effect, and vascular diameter is increased, plaque burden is decreased, stent placement rate and compliance rate are improved, and risk of adverse cardiovascular events is reduced. It is worth to be popularized.