紫杉醇药物涂层球囊用于治疗支架内再狭窄的临床研究

发布时间：2018-01-06 21:18

  本文关键词：紫杉醇药物涂层球囊用于治疗支架内再狭窄的临床研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 支架内再狭窄 药物涂层球囊 经皮冠状动脉治疗

【摘要】：目的:研究紫杉醇药物涂层球囊在治疗冠状动脉支架植入术后出现的支架内再狭窄病变中的有效性及安全性。方法:研究分析了 2015年05月至2015年12月期间就诊于辽宁省人民医院,经冠状动脉造影检查提示支架内再狭窄的患者33例,均采用紫杉醇药物涂层球囊(SeQuent Please)来处理再狭窄处病变,并于术后9-12个月进行冠状动脉造影检查。收集患者术前、术后、造影复查时的血管狭窄程度和最小内径等资料,应用SPSS 17.0统计软件对数据进行统计分析,观察患者应用药物涂层球囊治疗支架内再狭窄的介入治疗成功率、手术获益情况、病变节段内晚期管腔丢失情况、再狭窄复发率及心血管不良事件发生率等。结果:本研究所选取的33名患者在行普通球囊预扩张时的过程均顺利,未出现影响血流的夹层,并顺利应用紫杉醇药物涂层球囊对支架内再狭窄病变进行了治疗,所有病变药物球囊扩张时间持续49±3s,介入手术的即刻成功率为100%,住院期间无心血管不良事件发生。所有患者术后均给予了 3个月的双联抗血小板治疗,术后1、3、6个月临床随访无心绞痛再发、无其他心血管不良事件的发生。1名71岁男性患者在术后5个月时因为确诊肺部肿瘤,拒绝行冠状动脉造影检查。在术后9-12个月,共有32人参加了造影复查,造影随访率为97%(32/33),在参与冠状动脉造影复查的32名患者中,1名42岁男性患者在术后10个月时出现心绞痛症状,于我院复查造影,发现支架内复发再狭窄,最重狭窄90%,给予植入DES治疗,并更换抗血小板药(氯吡格雷改为替格瑞洛),之后未再发心绞痛症状。其余31名患者造影复查显示支架内未见明显再狭窄,也未再发心绞痛症状。术前后病变狭窄程度比较,患者术后与术前的病变狭窄程度有统计学差异[11.0±5.4%vs.77.6±8.9%,p0.05],患者造影复查时与术前的病变狭窄程度有统计学差异[12.9±4.9%vs.77.6±8.99%,P0.05],患者造影复查时与术后的病变狭窄程度无统计学意义[12.9 ± 4.9%vs.10.6 ±5.4%,P=0.173],应用药物涂层球囊治疗支架内再狭窄病变的手术即刻成功率为 100%。术前后病变最小内径比较,患者术后与术前的病变最小内径有统计学差异[3.02±0.40mmvs.0.69±0.25mm,p0.05],患者造影复查时与术前的病变最小内径有统计学差异[2.95±0.40mm vs.0.69±0.25mm,P0.05],患者造影复查时与术后的最小内径无统计学差异[2.95±0.40mm vs.3.02±0.40mm,P=0.173],应用药物涂层球囊治疗支架内再狭窄病变的手术即刻获益为 2.33 ±0.34mm。应用药物涂层球囊治疗支架内再狭窄病变术后9-12个月的晚期管腔丢失为0.07±0.18mm,与文献报道相一致。结论:1、应用紫杉醇药物涂层球囊治疗冠状动脉支架内再狭窄病变的围术期安全有效,手术即刻成功率为100%,手术即刻获益令人满意,住院期间未发生心血管不良事件。2、临床和造影随访:应用紫杉醇药物涂层球囊治疗冠状动脉支架内再狭窄病变的患者的术后9-12个月心绞痛复发率低,复发率为3.1%(1/32),且术后9-12个月复查冠状动脉造影显示病变节段晚期管腔丢失未见明显增高。
[Abstract]:Objective: the efficacy and safety of paclitaxel eluting stent balloon in the treatment of coronary artery stent implantation appears in stentrestenosis. Methods: analysis of the 2015 05 to December 2015 during visits to the Liaoning Provincial People's Hospital, underwent coronary angiography and prompt stent restenosis in 33 patients. Using paclitaxel eluting balloon (SeQuent Please) to treat restenosis lesions and coronary artery angiography 9-12 months after surgery. Patients were collected before surgery, postoperative vascular stenosis by angiography and the minimum diameter data, using SPSS 17 statistical software for statistical data analysis, observation patients with drug coated balloon for treatment of in stent restenosis interventional treatment success rate, operation benefit, segmental lesions in late lumen loss, restenosis rate and cardiovascular adverse The event rate. Results: This study selected 33 patients with normal balloon dilation of smooth, does not appear to affect blood flow and dissection, successful application of paclitaxel eluting balloon in stent restenosis lesions were treated, all lesions drug balloon time for 49 + 3S, success rate immediate surgical intervention was 100%, no adverse cardiovascular events during hospitalization. All patients were given 3 months of dual antiplatelet therapy, postoperative 1,3,6 months follow-up angina recurrence, no other adverse cardiovascular events.1 71 year old male patients in 5 months after operation because the diagnosis of lung cancer, to undergo coronary angiography. In 9-12 months after operation, a total of 32 people participated in the angiography angiographic follow-up rate was 97% (32/33), in 32 patients in the coronary angiography was performed in 1 at the age of 42 Male patients after 10 months of surgery anginal symptoms in our hospital, the angiography, stent restenosis was found recurrence, the most narrow 90%, give the implantation of DES treatment, and the replacement of antiplatelet drugs (clopidogrel to ticagrelor), after no recurrence of angina symptoms. The remaining 31 patients with angiography show no significant in stent restenosis, no recurrence of angina symptoms. Preoperative and postoperative stenosis, patients with stenosis before operation there was significant difference between the [11.0 + 5.4%vs.77.6 + 8.9%, p0.05], angiography and the patients with stenosis before operation had statistical difference between [12.9 + 4.9%vs.77.6 + 8.99%. P0.05], patients with angiography and stenosis after surgery had no statistically significant [12.9 + 4.9%vs.10.6 + 5.4%, P=0.173], the success rate of operation lesions with drugeluting stent restenosis was 100%. Minimum diameter of lesions before and after operation, postoperative and preoperative lesion minimum diameter had statistical difference between [3.02 + 0.40mmvs.0.69 + 0.25mm, p0.05], angiography and preoperative patients with lesions of minimum diameter had statistical difference between [2.95 + 0.40mm vs.0.69 + 0.25mm, P0.05], angiography and follow-up patients after operation was no minimum diameter the difference of [2.95 + 0.40mm vs.3.02 + 0.40mm, P=0.173], benefit lesions with drugeluting stent restenosis operation for late lumen 9-12 months was 0.07 + 0.18mm 2.33 + 0.34mm. application lost drugeluting stent restenosis lesions after operation, consistent with the reported lesions. Conclusion: 1. Paclitaxel eluting balloon in the treatment of coronary artery in stent restenosis in perioperative period is safe and effective, the success rate of operation was 100%, satisfactory operation benefit, no hospitalization The occurrence of cardiovascular adverse events.2, clinical and angiographic follow-up: low recurrence 9-12 months angina rate of lesions with paclitaxel eluting balloon in the treatment of coronary artery in stent restenosis in patients after surgery, the recurrence rate was 3.1% (1/32), and postoperative 9-12 months after coronary angiography showed segmental lesions late lumen loss there is no significant increase.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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本文编号：1389562