血管内超声（IVUS）在左主干病变介入治疗中的临床应用

发布时间：2018-04-21 06:12

本文选题：血管内超声 + 冠状动脉左主干病变　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:本研究评估IVUS指导对冠状动脉左主干病变患者经皮冠状动脉介入治疗(PCI)临床预后的影响。评估IVUS对含有“易损斑块”的左主干病变患者PCI术后的影响。方法:入选我院2012年01月-2016年01月共76例冠状动脉左主干病变并接受PCI治疗的患者。分为两组:1.IVUS组:29例冠状动脉左主干病变患者行PCI治疗,术中使用IVUS指导;2.造影组:47例冠状动脉左主干病变患者行PCI治疗,使用常规造影指导。通过虚拟组织学超声(VH-IVUS)识别的易损斑块又将IVUS组患者又分为两亚组:“易损斑块组(12例)”和“非易损斑块组(17例)”。随访的主要终点事件为主要心血管不良事件(MACE),包括:心源性死亡、心肌梗死和靶血管血运重建。比较IVUS组和冠脉造影组患者1年的主要终点事件发生率以及两亚组患者1年的主要终点事件发生率。结果:IVUS组患者与冠脉造影组相比术后1年的MACE事件发生率有降低趋势(6.9%versus 19.1%,log-rank P=0.072)。IVUS组术后1年的死亡率较冠脉造影组有降低趋势(0.0%versus 8.5%,log-rank P=0.080)。IVUS指导与冠脉造影指导相比不能降低患者术后心肌梗死和靶血管血运重建的发生率(0.0%versus 2.1%,log-rank P=0.355;6.9%versus 10.6%,log-rank P=0.349)。易损斑块组和非易损斑块组术后1年的MACE事件发生率相似(8.3%versus 5.9%,log-rank P=0.702)。结论:IVUS指导与冠脉造影指导相比有减少左主干病变患者PCI术后1年的MACE事件发生率的趋势。IVUS指导可能通过降低术后死亡率来优化预后,值得临床推广。与非易损斑块组相比,IVUS指导未增加易损斑块组患者PCI术后1年MACE事件的发生风险。
[Abstract]:Objective: to evaluate the effect of IVUS guidance on the prognosis of patients with left coronary artery disease after percutaneous coronary intervention (PCI). To evaluate the effect of IVUS on left main lesion with vulnerable plaque after PCI. Methods: from January 2012 to January 2016, 76 patients with left main coronary artery disease treated with PCI were enrolled. In IVUS group, 29 patients with left main coronary artery disease were treated with PCI, and 2 patients were treated with IVUS during operation. 2. In contrast group, 47 patients with left main coronary artery disease were treated with PCI and guided by conventional angiography. The vulnerable plaques identified by VH-IVUSwere subdivided into two subgroups: "vulnerable plaque group (n = 12)" and "non-vulnerable plaque group (n = 17)". The main endpoint events were major cardiovascular adverse events, including cardiac death, myocardial infarction and target vessel revascularization. The incidence of major end point events in IVUS group and coronary angiography group was compared with that in two subgroups. Results compared with the coronary angiography group, the incidence of MACE events in the first year of coronary angiography in the% IVUS group was lower than that in the coronary angiography group (6.9% vs 19.1log-rank P=0.072).IVUS). The mortality rate in the P=0.072).IVUS group was lower than that in the coronary angiography group (0.0versus 8.5%). The P=0.080).IVUS guidance could not be decreased compared with the coronary angiography group. The incidence of myocardial infarction and target vessel revascularization was 0.0versus 2.1, and log-rank P was 0.3556.9and log-rank P was 0.349. The incidence of MACE events in vulnerable plaque group and non-vulnerable plaque group was similar to that in vulnerable plaque group (8.3versus 5.9) and non-vulnerable plaque group (P < 0.702). Conclusion compared with coronary arteriography, the MACE events in patients with left main lesion after 1 year after PCI may be improved by reducing the mortality rate, which is worthy to be popularized in clinical practice. [conclusion] compared with coronary angiographic guidance, there is a tendency to reduce the incidence of MACE events in patients with left main lesion one year after operation. Compared with non-vulnerable plaque group, IVUS guidance did not increase the risk of MACE events 1 year after PCI in vulnerable plaque group.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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