刺破球囊技术在经皮冠状动脉介入治疗中的应用研究

Study on the application of puncture balloon technique in percutaneous coronary artery intervention therapy

目的探讨刺破球囊技术在经皮冠状动脉介入治疗中应用的安全性和有效性。方法选择2020年1月—2021年6月在本院诊断为急性冠脉综合征且行PCI治疗,术中出现慢血流/无复流现象的患者98例为研究对象,采用随机抽样方法分为观察组和对照组两组,每组各49例。观察组经刺破球囊靶病变部位注药,对照组经指引导管冠脉开口部位注药。比较两组患者冠脉内注药后2-3分钟的心肌梗死溶栓试验(TIMI)血流分级,术后即刻血流帧数计数(cTFC);两组患者注药前后对冠脉内血压的影响情况;PCI术后7天和3个月内的主要心脏不良事件发生情况。结果两组患者冠脉给药2-3分钟后观察组TIMI血流分级高于对照组(t=4.7297,P<0.0001),矫正的TIMI帧数(cTFC)明显低于对照组(t=3.7426,P<0.0001);两组治疗前后的收缩压、舒张压的变化值有差异(t'=-5.307,P<0.001;t'=-2.928,P=0.004);术后7天和3个月内的主要心脏不良事件发生率观察组明显低于对照组。结论PCI术中出现慢血流或无复流现象时,使用刺破球囊靶病变部位注药,可明显改善TIMI血流,且对冠脉内血压波动影响小,降低心血管不良事件发生率,提示刺破球囊技术注药安全有效。

Objective To investigate the safety and efficacy of puncture balloon technique that applied in percutaneous coronary artery intervention(PCI).Methods 98 patients,who were diagnosed with acute coronary syndrome and were treated with PCI during January 2020 and June 2020,with intraoperative slow blood flow/no re-flow were selected from the second affiliated hospital of Qiqihar Medical College.Patients were randomly divided into observation group and control group,49 cases in each group.The drug was injected into the target lesion site by puncture balloon.Drug was injected at the opening of coronary artery by guiding catheter.The blood flow grading of thrombolysis in myocardial infarction(TIMI)at 2 to 3 minutes after coronary infusion,corrected TIMI frame count(cTFC),the influence on intracoronary blood pressure before and after drug injection in the two groups and incidence of major adverse cardiac events 7d and 3 months after PCI were compared between the two groups.Results TIMI blood flow grading in the observation group was higher than that in the control group at 2-3 minutes after coronary artery administration(t=4.7297,P<0.0001).The corrected TIMI frame number(cTFC)was significantly lower than that of the control group(t=3.7426,P<0.0001).There were significant differences in systolic and diastolic blood pressure between the two groups before and after treatment(t'=-5.307,P<0.001;t'=-2.928,P=0.004).The incidence of major adverse cardiac events at 7 days and 3 months after operation was significantly lower in the observation group than in the control group.Conclusions When slow blood flow or no re-flow occurred during PCI.The application of punctured balloon inject drugs at target lesion site could significantly improve TIMI blood flow,and it has little influence on the fluctuation of blood pressure in coronary artery,reduces the incidence of cardiovascular adverse events.It is suggested that puncture balloon technique is safe and effective.