冠状动脉血管内超声对冠心病患者冠状动脉病变的诊断及冠脉支架置入术的指导价值分析

Analysis of Diagnostic Value of the Intravascular Ultrasound in the Diagnosis of Coronary Artery Disease and Guiding Value of Stent Implantation in Patients with Coronary Heart Disease

目的:探讨冠状动脉血管内超声(IVUS)对冠心病(CHD)患者冠状动脉病变的诊断及冠脉支架置入术(PCI)的指导价值。方法:选择2017年1月至2019年1月我院收治的200例CHD患者,其中急性冠脉综合征(ACS)115例,慢性心肌缺血综合征(CIS)85例;经冠脉造影证实单支病变患者62例(单支组),双支病变患者81例(双支组),三支及以上病变患者57例(多支组)。比较不同冠脉病变支数、病变程度CHD患者斑块性质、管腔面积、外弹力膜面积、斑块面积、斑块负荷、狭窄率。随机将115例ACS患者分为观察组(58例)和对照组(57例),比较两组PCI手术支架置入率、达标率以及手术前后管腔面积、斑块面积、斑块负荷、狭窄率。PCI术后随访12个月,比较两组术后再狭窄和主要不良心脏事件(MACE)发生情况。结果:200例患者共检出415块斑块,ACS组颈动脉斑块性质以低回声斑居多,CIS组以等、高回声斑居多(P<0.05),ACS组管腔面积小于CIS组,斑块面积、斑块负荷、狭窄率高于CIS组(P<0.05)。多支组斑块性质以低回声斑居多,双支组以等回声斑居多,单支组以高回声斑居多(P<0.05)。管腔面积随着冠脉病变支数的增加而降低,斑块面积、斑块负荷、狭窄率随着冠脉病变支数的增加而升高(P<0.05)。观察组支架置入率、达标率、术后管腔面积高于对照组,斑块面积、斑块负荷、狭窄率低于对照组(P<0.05)。观察组PCI术后12个月再狭窄率、MACE发生率低于对照组(P<0.05)。结论:冠状动脉IVUS可较为准确地评估冠脉病变程度,相较于传统的冠状动脉造影,基于冠状动脉IVUS指导PCI手术可提高手术效果。

Objective:To investigate the diagnostic value of intravascular ultrasound(IVUS)in coronary artery disease(CHD)patients and the guiding value of PCI.Methods:200 CHD patients admitted to our hospital from January 2017 to January 2019 were selected.There were 115 cases of acute coronary syndrome(ACS)and 85 cases of chronic myocardial ischemia syndrome(CIS).62 patients with single-vessel lesion(single-vessel group),81 patients with double-vessel lesion(double-vessel group),and 57 patients with three-vessel lesion or more(multiple-vessel group)confirmed by coronary angiography.The differences of plaque nature,lumen area,outer elastic membrane area,plaque area,plaque load and stenosis rate were compared among CHD patients with different number of coronary artery lesions and lesion degree.115 ACS patients were randomly divided into observation group(58 cases)and control group(57 cases).The stent placement rate,compliance rate,and the changes and differences in lumen area,plaque area,plaque load,stenosis rate before and after PCI were compared between the two groups.All patients were followed up for 12 months,postoperative restenosis and major adverse cardiac events(MACE)were compared between the two groups.Results:A total of 415 plaques were detected in 200 patients.In ACS group,hypoechoic plaques were the most common,while isoechoic plaques and hyperechoic plaques were more common in CIS group(P<0.05).The lumen area of ACS group was smaller than that of CIS group,and the plaque area,plaque load and stenosis rate were higher than that of CIS group(P<0.05).In the multi vessel group,hypoechoic plaques were more common,isoechoic plaques were more common in the double vessel group,and hyperechoic plaques in the single vessel group(P<0.05).The lumen area decreased with the increase of the number of coronary lesions,while the plaque area,plaque load and stenosis rate increased with the increase of the number of coronary lesions(P<0.05).The stent implantation rate,compliance rate and lumen area in the observation group were higher than those in the control group,while the plaque area,plaque load and stenosis rate were lower than those in the control group(P<0.05).The restenosis rate and MACE incidence in the observation group were lower than those in the control group 12 months after PCI(P<0.05).Conclusion:Compared with the traditional coronary angiography,coronary IVUS has a high value in the assessment of the degree of coronary artery lesions,and guiding PCI can improve the surgical effect.