冠状动脉介入治疗中“门卫”导丝技术应用的安全性及可行性

Safety and feasibility of guard wire technology during percutaneous coronary intervention

目的 分析冠状动脉口部病变行冠状动脉介入治疗（PCI）或冠状动脉口部存在病变（无需PCI）而在该冠状动脉远端病变严重行PCI术中，应用“门卫”导丝技术的安全性及可行性。方法 选取2011年10月~2015年11月平顶山市第一人民医院心内科冠状动脉口部病变行PCI术的患者41例，其中男性23例，女性18例，随机分为A组（21例）、B组（20例）；同时选取冠状动脉口部存在病变（无需PCI）而在该冠状动脉远端病变严重需行PCI术的患者52例，其中男性27例，女性25例，随机分为C组（28例）、D组（24例）。A组及C组应用“门卫”导丝技术，导丝放置后行PCI术；B组及D组采用标准术式，通过靶病变血管放置指引导丝后，行球囊扩张和支架置入术。分别统计X线曝光时间、对比剂用量、PCI总时间、压力嵌顿次数、恶性心律失常例数、手术失败例数等相关指标。结果 B组X线曝光时间、对比剂用量、PCI总时间、压力嵌顿比例较A组增加，差异具有统计学意义（P均＜0.05）。A组患者未发生恶性心律失常及PCI失败情况，B组患者发生恶性心律失常5例，PCI失败4例。D组对比剂用量、PCI失败比例较C组增多，差异具有统计学意义（P均＜0.01）。结论 冠状动脉口部病变行PCI术或冠状动脉口部存在病变（无需PCI）而在该冠状动脉远端病变严重行PCI术中，应用“门卫”导丝技术有较好的安全性及可行性。

Objective To analyze the safety and feasibility of guard wire technology during percutaneouscoronary intervention (PCI) in patients with coronary ostial lesions. Methods The patients undergone PCI (n=41,male 23 and female 18) were chosen from the First People’s Hospital of Pingdingshan City from Oct. 2011 toNov. 2015, and then randomly divided into group A (n=21) and group B (n=20). Other patients not undergonePCI (n=52, male 27 and female 25) were chosen, and then randomly divided into group C (n=28) and group D(n=24). Group A and group C were given PCI after using guard wire technology, and group B and group C weregiven balloon dilation and stenting after placing guide wire through target lesion vessel. X-ray exposure time,contrast agent dosage, total PCI duration, pressure incarceration times, cases of malignant arrhythmia and casesof failed PCI were detected respectively. Results X-ray exposure time, contrast agent dosage, total PCI durationand percentage of pressure incarceration increased in group B compared with group A (all P<0.05). There were nocases of malignant arrhythmia and cases of failed PCI in group A, and there were 5 of malignant arrhythmia and 4 offailed PCI. Contrast agent dosage and cases of failed PCI increased in group D compared with group C (all P<0.01).Conclusion The guard wire technology has higher safety and feasibility in the patients with coronary ostial lesionsundergone PCI.